Department of Cardiology, Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands.
Department of Radiotherapy, Leiden University Medical Center, The Netherlands.
Radiother Oncol. 2017 Oct;125(1):55-61. doi: 10.1016/j.radonc.2017.09.008. Epub 2017 Oct 4.
Patients who received chest irradiation for treatment of a malignancy are at increased risk for the development of coronary artery atherosclerosis. Little is known about the anatomical coronary artery plaque characteristics of irradiation induced coronary artery disease (CAD). This study aimed to evaluate potential differences in the presence, extent, severity, composition and location of CAD in patients treated with mediastinal irradiation compared with non-irradiated controls matched on age, gender and cardiovascular risk factors.
Seventy-nine asymptomatic Hodgkin and non-Hodgkin lymphoma survivors, all treated with mediastinal irradiation with or without chemotherapy, who underwent coronary computed tomography angiography (CTA) to exclude or detect CAD were included. Patients were 1:3 matched with non-irradiated controls (n=237) for age, gender, diabetes, hypertension, hypercholesterolemia, family history of CAD and currently smoking. Mean age at cancer diagnosis was 26±9years and age at the time of coronary CTA was 45±11years.
More patients had an abnormal CTA (defined as any coronary artery atherosclerosis): 59% vs. 36% (P<0.001) and significantly more patients had two vessel CAD: 10% vs. 6% and three vessel/left main CAD: 24% vs. 9% compared with controls (overall P<0.001). The maximum stenosis severity among patients was less often <30% (53% vs. 68%) and more often >70% (7% vs. 0%) (overall P=0.001). Patients had more coronary artery plaques in proximal coronary artery segments: left main (17% vs. 6%, P=0.004), proximal left anterior descending artery (30% vs. 16%, P=0.004), proximal right coronary artery (25% vs 10%, P<0.001) and proximal left circumflex artery (14% vs 6%, P=0.022), whereas the number of plaques in non-proximal segments did not differ between groups.
Hodgkin and non-Hodgkin lymphoma survivors treated with mediastinal irradiation with or without chemotherapy showed a higher presence, greater severity, larger extent and more proximally located CAD compared with age, gender and risk factor matched non-irradiated controls. These findings represent features of higher risk CAD and may explain the worse cardiovascular outcome after chest irradiation.
接受胸部放疗治疗恶性肿瘤的患者发生冠状动脉粥样硬化的风险增加。关于放疗引起的冠状动脉疾病（CAD）的解剖学冠状动脉斑块特征，人们知之甚少。本研究旨在评估与未接受照射的年龄、性别和心血管危险因素相匹配的对照组相比，接受纵隔照射治疗的患者 CAD 的存在、程度、严重程度、成分和位置是否存在差异。
纳入了 79 例无症状霍奇金和非霍奇金淋巴瘤幸存者，所有患者均接受纵隔放疗（伴或不伴化疗），并接受冠状动脉计算机断层扫描血管造影（CTA）以排除或检测 CAD。将患者按年龄、性别、糖尿病、高血压、高胆固醇血症、CAD 家族史和目前吸烟情况与非照射对照组（n=237） 1:3 匹配。癌症诊断时的平均年龄为 26±9 岁，冠状动脉 CTA 时的年龄为 45±11 岁。
更多的患者 CTA 异常（定义为任何冠状动脉粥样硬化）：59%比 36%（P<0.001），并且显著更多的患者存在两血管 CAD：10%比 6%和三血管/左主干 CAD：24%比 9%（总体 P<0.001）。患者的最大狭窄严重程度<30%的情况较少（53%比 68%），而>70%的情况较多（7%比 0%）（总体 P=0.001）。患者近端冠状动脉节段的冠状动脉斑块更多：左主干（17%比 6%，P=0.004）、左前降支近端（30%比 16%，P=0.004）、右冠状动脉近端（25%比 10%，P<0.001）和左回旋支近端（14%比 6%，P=0.022），而非近端节段的斑块数量在两组之间没有差异。
接受纵隔放疗（伴或不伴化疗）治疗的霍奇金和非霍奇金淋巴瘤幸存者与年龄、性别和危险因素相匹配的未照射对照组相比，存在更高的 CAD 发生率、更严重的 CAD、更大的 CAD 范围和更靠近近端的 CAD。这些发现代表了更高风险 CAD 的特征，可能解释了胸部放疗后心血管不良结局的原因。
