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Contrast enhanced cardiac CT reveals coronary artery disease in 45% of asymptomatic allo-SCT long-term survivors

Bone Marrow Transplantation volume 49, pages 451–452 (2014)Cite this article

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Long-term survivors of allo-SCT face a two- to threefold increased risk of premature cardiovascular (CV)-related death compared to the general population.1, 2, 3 After allo-SCT chronic inflammation and endothelial damage from GVHD, immunosuppression, hypogonadism and metabolic syndrome compound with classical CV risk factors such as diabetes, dyslipidemia, hypertension and renal disease to augment CV risk.4, 5, 6 A reliable screening strategy to identify allo-SCT survivors at risk for CV-related disease is therefore warranted to anticipate and prevent future events. Cardiac computed tomography (CCT) is an emerging non-invasive imaging technology with high sensitivity for detecting coronary artery disease (CAD) and high negative predictive value to exclude the presence of CAD.7 Coronary artery calcium (CAC) is a marker of atherosclerosis, which can be quantified by CCT, and is proportional to the extent and severity of atherosclerotic disease.7

We conducted the first prospective non-randomized single institution study to evaluate Agatston coronary calcium scoring (CCS) by CCT with concomitant coronary CT angiograms (CCTA) as a tool to identify the survivors at risk for CV disease. Twenty asymptomatic post allo-SCT survivors underwent CCS and contrast enhanced CCTA at a median follow up of 6 years post transplant. Patient characteristics are shown in Table 1. Ten-year Framingham CV risk scores (FRS) were also calculated at the time of screening. Subjects were prepared for coronary CTA according to standard guidelines.8

Table 1 Patient characteristics
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References

  1. Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG et al. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood 2007; 110: 3784–3792.

    Article  CAS  Google Scholar 

  2. Tichelli A, Passweg J, Wojcik D, Rovo A, Harousseau JL, Masszi T et al. Late cardiovascular events after allogeneic hematopoietic stem cell transplantation: a retrospective multicenter study of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2008; 93: 1203–1210.

    Article  Google Scholar 

  3. Savani BN, Griffith ML, Jagasia S, Lee SJ . How I treat late effects in adults after allogeneic stem cell transplantation. Blood 2011; 117: 3002–3009.

    Article  CAS  Google Scholar 

  4. Baker KS, Chow E, Steinberger J . Metabolic syndrome and cardiovascular risk in survivors after hematopoietic cell transplantation. Bone Marrow Transplant 47: 619–625.

  5. Pophali PA, Klotz JK, Ito S, Koklanaris E, Jain NA, Le RQ et al. Male survivors of allogeneic hematopoietic stem cell transplantation have a long term persisting risk of cardiovascular events. Exp Hematol, (e-pub ahead of print 16 October 2013; doi:10.1016/J.exphem.2013.07.003).

  6. Majhail NS, Flowers ME, Ness KK, Jagasia M, Carpenter PA, Arora M et al. High prevalence of metabolic syndrome after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2009; 43: 49–54.

    Article  CAS  Google Scholar 

  7. Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1764 patients. J Am Coll Cardiol 2001; 37: 451–457.

    Article  CAS  Google Scholar 

  8. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006; 114: 1761–1791.

    Article  Google Scholar 

  9. Abbara S, Arbab-Zadeh A, Callister TQ, Desai MY, Mamuya W, Thomson L et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2009; 3: 190–204.

    Article  Google Scholar 

  10. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358: 1336–1345.

    Article  CAS  Google Scholar 

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Acknowledgements

This research was supported by the Intramural Research Program of the National Heart, Lung and Blood Institute, National Institutes of Health.

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Authors and Affiliations

  1. Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA

    N A Jain, K Lu, P A Pophali, S Ito, E Koklanaris, C S Hourigan, A J Barrett & M Battiwalla

  2. Cardiopulmonary Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA

    M Y Chen & S Shanbhag

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  1. N A Jain
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Correspondence to M Battiwalla.

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Jain, N., Chen, M., Shanbhag, S. et al. Contrast enhanced cardiac CT reveals coronary artery disease in 45% of asymptomatic allo-SCT long-term survivors. Bone Marrow Transplant 49, 451–452 (2014). https://doi.org/10.1038/bmt.2013.182

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