Polomski Elissa A S, de Graaf Michiel A, Jukema J Wouter, Antoni M Louisa
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
J Cardiovasc Dev Dis. 2023 Jul 31;10(8):324. doi: 10.3390/jcdd10080324.
Major improvements in cancer therapies have significantly contributed to increased survival rates of Hodgkin lymphoma (HL) survivors, outweighing cardiovascular side effects and the risks of radiation-induced heart disease. Non-invasive screening for coronary artery disease (CAD) starting five years after irradiation is recommended, as plaque development and morphology may differ in this high-risk population. Due to rapid plaque progression and a possibly higher incidence of non-calcified plaques, coronary artery calcium scoring may not be sufficient as a screening modality in HL survivors treated with thoracic radiotherapy.
A 42-year-old man with a history of HL treated with thoracic radiotherapy presented at the emergency department 20 years after cancer treatment with an ST-elevation myocardial infarction, in the absence of cardiovascular risk factors, for which primary percutaneous coronary intervention of the left anterior descending artery was performed. Four months prior to acute myocardial infarction, invasive coronary angiography only showed wall irregularities. Two years earlier, the Agatston calcium score was zero.
In HL survivors treated with thoracic radiotherapy, a calcium score of zero may not give the same warranty period for cardiac event-free survival compared to the general population. Coronary computed tomography angiography can be a proper diagnostic tool to detect CAD at an early stage after mediastinal irradiation, as performing calcium scoring may not be sufficient in this population to detect non-calcified plaques, which may show rapid progression and lead to acute coronary syndrome. Also, intensive lipid-lowering therapy should be considered in the presence of atherosclerosis in this patient population.
癌症治疗的重大进展显著提高了霍奇金淋巴瘤（HL）幸存者的生存率，超过了心血管副作用和辐射诱发心脏病的风险。建议在放疗后五年开始对冠状动脉疾病（CAD）进行非侵入性筛查，因为在这一高危人群中斑块的发展和形态可能有所不同。由于斑块进展迅速且非钙化斑块的发生率可能更高，冠状动脉钙化评分作为接受胸部放疗的HL幸存者的筛查方式可能并不充分。
一名42岁有HL病史且接受过胸部放疗的男性，在癌症治疗20年后因ST段抬高型心肌梗死就诊于急诊科，其无心血管危险因素，对左前降支进行了直接经皮冠状动脉介入治疗。急性心肌梗死前四个月，侵入性冠状动脉造影仅显示血管壁不规则。两年前，阿加斯顿钙化评分为零。
与普通人群相比，接受胸部放疗的HL幸存者中，钙化评分为零可能无法保证相同的无心脏事件生存期。冠状动脉计算机断层扫描血管造影可以作为纵隔放疗后早期检测CAD的合适诊断工具，因为在这一人群中进行钙化评分可能不足以检测到非钙化斑块，这些斑块可能进展迅速并导致急性冠状动脉综合征。此外，对于该患者群体中存在动脉粥样硬化的情况，应考虑强化降脂治疗。
