Framingham Risk Score Is an Ineffective Screening Strategy for Coronary Heart Disease in Long-Term Allogeneic Hematopoietic Cell Transplant Survivors

Authors

Natasha A. Jain^{1, †,} , Marcus Y. Chen^{2, †}, Sujata Shanbhag², Prathima Anandi¹, Xin Tian³, Sawa Ito¹, Priyanka A. Pophali¹, Kimberly Doucette¹, Robert Q. Le¹, Upneet Chawla¹, Eleftheria Koklanaris¹, Richard W. Childs¹, A. John Barrett¹, Minoo Battiwalla^{1, 4, *}

¹Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

²Cardiopulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

³Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

⁴Sarah Cannon Blood Cancer Network, Nashville, TN, USA

^†

Contributed equally

^*Corresponding author. Postal address: Tristar Centennial Blood and Marrow Transplant, 2300 Patterson Street, 5th Floor, Nashville, TN 37203, USA. Tel.: +1 301 742 7782; Fax: +1 615 342 7462; Email: minoo.battiwalla@hcahealthcare.com

DOI

10.2991/chi.d.200508.001How to use a DOI?

Keywords

Coronary CT angiogram; cardiovascular risk; survivorship; BMT; late effects

Abstract

Long-term allogeneic hematopoietic cell transplant (allo-HCT) survivors suffer an elevated risk of coronary heart disease (CHD). We conducted a prospective, nonrandomized, cross-sectional study to screen asymptomatic survivors at a single allo-HCT center using cardiac computed tomography (CT) involving coronary CT angiography (CCTA) and the coronary artery calcium (CAC) score. Seventy-nine subjects with a median age of 39 years at allo-HCT and a median follow-up interval of 8 years were evaluated for CHD by Framingham Risk Score (FRS) and cardiac CT. CHD was detected in 33 of 79 (42%) subjects; 91% of lesions were nonobstructive, 19.5% of were noncalcified and 30% had associated valvular calcification. Overall, CAC was significantly superior to FRS in detecting early CHD in allo-HCT survivors [∆C = 0.25; P < 0.0001]. While both FRS and CAC were highly, >95% specific, FRS had a sensitivity, positive and negative predictive values of only 28% (95% CI, 14%–47%), 90% (95% CI, 55%–100%) and 60% (95% CI, 47%–73%), respectively. In contrast, the sensitivity, positive and negative predictive values of CAC were 78% (95% CI, 60%–91%), 96% (95% CI, 80%–100%) and 83% (95% CI, 69%–93%), respectively. Significantly, cardiac CT detected CHD in 23 of the 68 (34%) survivors deemed to have a low Framingham risk. Radiation exposure during cardiac CT was negligible, and there were no adverse events. In conclusion, CAC score with or without CCTA is a safe, feasible and sensitive screening technique for CHD. The FRS greatly underestimates CHD in allo-HCT survivors.

Copyright

© 2020 National Institutes of Health. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Download article (PDF)
View full text (HTML)

TY  - JOUR
AU  - Natasha A. Jain
AU  - Marcus Y. Chen
AU  - Sujata Shanbhag
AU  - Prathima Anandi
AU  - Xin Tian
AU  - Sawa Ito
AU  - Priyanka A. Pophali
AU  - Kimberly Doucette
AU  - Robert Q. Le
AU  - Upneet Chawla
AU  - Eleftheria Koklanaris
AU  - Richard W. Childs
AU  - A. John Barrett
AU  - Minoo Battiwalla
PY  - 2020
DA  - 2020/06/12
TI  - Framingham Risk Score Is an Ineffective Screening Strategy for Coronary Heart Disease in Long-Term Allogeneic Hematopoietic Cell Transplant Survivors
JO  - Clinical Hematology International
SP  - 109
EP  - 116
VL  - 2
IS  - 3
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.d.200508.001
DO  - 10.2991/chi.d.200508.001
ID  - Jain2020
ER  -