59 Cardiac CT Imaging Is a Feasible Screening Strategy for Coronary Artery Disease (CAD) in Long Term Allogeneic Stem Cell Transplant (Allo-SCT) Survivors

Track: BMT Tandem "Scientific" Meeting
Friday, February 13, 2015, 10:30 AM-12:00 PM
Seaport Ballroom DE (Manchester Grand Hyatt)
Natasha A Jain, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Marcus Y Chen, MD , Cardiology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Sujata Shanbhag, MD , Cardiology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Prathima Anandi, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Kit Lu, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Priyanka A Pophali, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Neil Dunavin, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Sawa Ito, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Eleftheria Koklanaris, RN , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Christopher S. Hourigan, MD, PhD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
A. John Barrett, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Minoo Battiwalla, MD, MS , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Audio File Recorded Presentation
Introduction:  Significant increases in CAD risk and cardiovascular events have been described in long-term allo-SCT survivors compared to age and gender-matched population controls. Since pharmacologic interventions, such as statins, positively influence the evolution of CAD and subsequent cardiovascular events, an effective screening strategy is essential.  Screening for CAD has hitherto relied upon clinical assessments such as the Framingham cardiovascular risk score but the optimum screening strategy in this unique population is undefined.

Method:  We conducted a prospective non-randomized study using cardiac CT to evaluate Agatston coronary calcium scoring by CT with concomitant coronary CT angiography for screening asymptomatic allo-SCT survivors.  55 subjects (32 males; 23 females) with a median age of 41 years (range 17 - 69) at transplant and a median follow up interval of 10 years (range: 4-21) were studied.  Angiography was excluded in 5 subjects with renal dysfunction. CAD was defined as presence of lesions on CT angio and/or calcium score > 0 (for subjects without angiography).  10-year Framingham scores were also calculated:  3 were classified as high risk, 5 were intermediate and 47 were low risk.

Results:  CAD was detected in 24 of 55 (44%) subjects. Characteristics of coronary plaques were: 21.5% calcified, 55% mixed calcified / non-calcified, and 23.5% non-calcified. Coronary lesions were mostly non-obstructive (86%), but obstructive lesions were seen in 14%. Lesion distributions by arterial territory were: left main 12.8%, left anterior descending 30.8%, left circumflex 23.1% and right coronary artery 33.3%. Additionally, 16 (67%) patients with CAD had either aortic root or mitral valvular calcification.

Radiation exposure during the procedure was negligible, at a median of 0.72 mSv for the coronary calcium score and 1.12 mSv for the coronary CT angiogram.  There were no adverse events.

Coronary calcium scoring had a sensitivity of 73% (95% C.I. 55% to 85%) and a specificity of 100% (95% C.I. 86% to 100%) compared to CT angiography. In addition, calcium score was able to detect CAD in 2 of 5 subjects who could not have angiograms because of renal dysfunction. Current (2010 AHA/ACC) guidelines suggest a role for coronary calcium scoring for screening asymptomatic non-transplant individuals with intermediate Framingham risk.  However, cardiac CT detected CAD in 18 of 47 (38.3%) low Framingham risk survivors. Coronary calcium scoring alone may be adequate for screening and avoids the use of IV contrast.

Conclusion: Accelerated CAD was detected in 44% of our alloSCT survivors by cardiac CT screening. Coronary calcium score with or without CT angiogram is a safe, feasible and sensitive screening technique for CAD. It is informative even in asymptomatic, low-risk survivors and is far more sensitive than the Framingham risk score.

Disclosures:
Nothing To Disclose
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