Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance
Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance
复制标题
DOI：
10.1093/annonc/mdu130
复制
发表时间：
2014-06-01
影响因子：
50.5
通讯作者：
Creutzberg, C. L.
中科院分区：
文献类型：
--
作者：
Daniels, L. A.;Krol, A. D. G.;Creutzberg, C. L.
心血管疾病是霍奇金淋巴瘤（HL）幸存者最常见的非恶性死亡原因，尤其是在纵隔照射后。我们研究了计算机断层冠状动脉造影（CTA）作为无症状HL幸存者冠状动脉疾病（CAD）筛查工具的作用，以及CTA结果与运动测试和随后的干预措施的相关关系。如果患者至少10年无病且接受过纵隔放疗，则符合参加这项II期研究的条件。筛查包括心电图、运动试验和CTA。主要终点为CTA显着CAD（狭窄bbb50 %）。如果50名CTA扫描患者中有千分之一（12%）需要血运重建，则认为CTA筛查可用于更大人群的检测。筛查前后分别用问卷进行评估。纳入52例患者，48例患者行CTA。中位年龄为47岁，诊断为HL的时间为21年。有45个可评估的扫描。CTA上有显著CAD的占20% (N = 9)，显著高于预期异常的7% （P = 0.01, 95%可信区间为8.3% ~ 31.7%）。11% （N = 5）的患者在冠状动脉造影中发现明显狭窄，并进行了血运重建术。此外，两名患者接受了最佳药物治疗。无论CTA是否显示异常，90%的患者对筛查满意。在HL幸存者中，显著CAD的患病率很高，即使存在危及生命的CAD，也无症状。这可能证明在接受纵隔放疗的无症状HL幸存者中进行CTA筛查是合理的，但需要在更大的队列中进行评估。该试验方案已获LUMC伦理委员会批准，并在ClinicalTrials.gov注册，编号NCT01271127。
Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions.Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis > 50%) on CTA. CTA screening was considered to be indicated for testing in a larger population if a parts per thousand yen6 of 50 CTA scanned patients (12%) would need revascularization. Screening was evaluated with a questionnaire before and after screening.Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20% (N = 9), significantly increased compared with the 7% expected abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities.Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127.