Chest Computed Tomography for Lymphoma Staging: A Wasted Opportunity for Cardiovascular Risk Stratification?

Aim Patients with a lymphoma diagnosis undergo non-gated chest computed tomography (CT) scans as part of cancer diagnosis or staging. Although coronary artery calcification fi cation (CAC) is traditionally evaluated on dedicated cardiac CT, CAC can also be detected on standard chest CT. This exploratory study aimed to determine the prognostic value of CAC detected on non-gated chest CT and to report its use on clinical practice. Method Consecutive patients with a lymphoma diagnosis who performed non-contrasted non-gated chest CT for cancer diagnosis or staging were included and retrospectively evaluated. Coronary artery calcifi- fi- cation was evaluated by quantitative (Agatston score) and qualitative (visual) assessment. Results Fifty-seven patients were included in this study (mean age 61615 6 15 years; 58% male). Coronary artery calcification fi cation was identified fi ed in 22 patients (39%), most of them with multi-vessel involvement. Coronary artery calcification fi cation was qualitatively classified fi ed as mild, moderate and severe in 11%, 19% and 9% patients, respectively. This study suggested that moderate or severe CAC was an independent predictor of all-cause mortality (odds ratio 3, 95% confidence fi dence interval 2-11; p=0.04) after adjusting for cardiovascular risk factors and lymphoma staging. Regarding quantitative evaluation, a higher CAC score was also associated with higher mortality. While significant fi cant CAC was identified fi ed in 22 patients, it was only reported in four patients. Conclusions The preliminary fi ndings of this hypothesis-generating study support the investigation of CAC identifi ed by chest CT for diagnosis/staging of cancer as a risk modifier fi er in the global risk assessment of patients with lymphoma. The unrecognition and underreporting of this fi nding may represent a wasted opportunity to detect subclinical coronary atherosclerosis in these patients and may help in guiding care.