Framingham Risk Score Is an Ineffective Screening Strategy for Coronary Heart Disease in Long-Term Allogeneic Hematopoietic Cell Transplant Survivors
- 10.2991/chi.d.200508.001How to use a DOI?
- Coronary CT angiogram; cardiovascular risk; survivorship; BMT; late effects
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.
- © 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/).
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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 -