Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Internal Medicine, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, Brazil.
Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Soc Echocardiogr. 2017 Nov;30(11):1111-1118. doi: 10.1016/j.echo.2017.07.016. Epub 2017 Sep 15.
Patients with acute leukemia (AL) have a higher rate of congestive heart failure than patients with other cancers. AL may predispose to cardiac dysfunction before chemotherapy because of high cytokine release or direct leukemic myocardial infiltration. The aims of this study were to evaluate whether AL is associated with abnormalities of myocardial structure and function before chemotherapy and to identify possible risk factors associated with these myocardial changes.
Using an echocardiographic database, 76 patients with AL and 76 patients without cancer matched for age, gender, hypertension, and the presence of diabetes were retrospectively selected. Subsequently, to assess the effect of a nonhematologic malignancy, 28 women in each group were matched with women with breast cancer. Left ventricular (LV) mass, volumes, ejection fraction, and global longitudinal strain (GLS) were measured before chemotherapy.
The patients were predominantly male (63%), with a median age of 51 years, and had low prevalence of cardiovascular risk factors. Despite similar LV ejection fractions, patients with AL had higher LV mass and volumes and lower GLS (-19.3 ± 2.7% vs -20.9 ± 1.9%, P < .001) than patients without cancer. Similarly, GLS was lower in women with AL compared with women with breast cancer or without cancer. Among patients with AL, high body mass index, low LV ejection fraction, and a small number of circulating lymphocytes were all independently associated with low GLS.
Patients with AL had higher LV volumes and lower GLS than patients without cancer and lower GLS than patients with breast cancer, suggesting that AL by itself may be associated with these cardiac alterations.
与其他癌症患者相比，急性白血病（AL）患者充血性心力衰竭的发生率更高。由于高细胞因子释放或直接白血病心肌浸润，AL 可能在化疗前导致心脏功能障碍。本研究旨在评估 AL 是否与化疗前心肌结构和功能异常相关，并确定与这些心肌变化相关的可能危险因素。
使用超声心动图数据库，回顾性选择 76 例 AL 患者和 76 例年龄、性别、高血压和糖尿病相匹配的无癌症患者。随后，为评估非血液系统恶性肿瘤的影响，在每组中匹配 28 例患有乳腺癌的女性。在化疗前测量左心室（LV）质量、容量、射血分数和整体纵向应变（GLS）。
患者主要为男性（63%），中位年龄为 51 岁，心血管危险因素的患病率较低。尽管 LV 射血分数相似，但与无癌症患者相比，AL 患者的 LV 质量和容量更高，GLS 更低（-19.3±2.7%比-20.9±1.9%，P<0.001）。同样，与乳腺癌或无癌症患者相比，AL 患者的 GLS 也较低。在 AL 患者中，高体质指数、低 LV 射血分数和循环淋巴细胞数量少均与低 GLS 独立相关。
与无癌症患者相比，AL 患者的 LV 容量更高，GLS 更低，与乳腺癌患者相比，GLS 更低，提示 AL 本身可能与这些心脏改变相关。
