Kang Yu, Assuncao Bruna Leal, Denduluri Srinivas, McCurdy Shannon, Luger Selina, Lefebvre Bénédicte, Carver Joseph, Scherrer-Crosbie Marielle
Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Departamento de Medicina, Universidade Federal de Sao Paulo, UNIFESP, Sao Paulo-SP, Brazil.
JACC CardioOncol. 2019 Dec;1(2):208-217. doi: 10.1016/j.jaccao.2019.10.008. Epub 2019 Dec 17.
The purpose of this study was to investigate the occurrence and develop a risk score for heart failure (HF) in acute leukemia.
Knowledge is scarce regarding the incidence and risk factors of symptomatic HF in patients with acute leukemia.
Baseline clinical and echocardiographic parameters, including indices of cardiac function (left ventricular ejection fraction and myocardial strain [global longitudinal strain; GLS]), were obtained in 450 patients with acute leukemia treated with anthracyclines, before chemotherapy initiation. Potential risk factors for HF were evaluated using Fine and Gray's regression analysis, and from this, a 21-point risk score was generated.
Forty patients (8.9%) developed HF. The HF risk score included a baseline GLS >-15% (indicative of greater impairment) (6 points), baseline left ventricular ejection fraction <50%, pre-existing cardiovascular disease, acute myeloid leukemia (4 points each), cumulative anthracycline dose ≥250 mg/m (2 points), and age >60 years (1 point). Patients were stratified into low (score 0 to 6), moderate (score 7 to 13), and high risk (score 14 to 21). The estimated 1-year cumulative incidence of HF for low-, moderate-, and high-risk groups was 1.0%, 13.6%, and 35.0%, respectively (p < 0.001). The HF risk score was also predictive of all-cause mortality (p < 0.001). After adjustment for age and leukemia type, however, only GLS was significantly associated with all-cause mortality (hazard ratio: 1.73; 95% confidence interval: 1.30 to 2.31; p < 0.001).
We developed a baseline risk score to determine risk of HF in patients with acute leukemia. Additional studies are needed to determine the external validity of these findings.
本研究旨在调查急性白血病患者心力衰竭（HF）的发生率，并制定HF风险评分。
关于急性白血病患者症状性HF的发病率和危险因素的了解较少。
在450例接受蒽环类药物治疗的急性白血病患者化疗开始前，获取基线临床和超声心动图参数，包括心功能指标（左心室射血分数和心肌应变[整体纵向应变；GLS]）。使用Fine和Gray回归分析评估HF的潜在危险因素，并据此生成一个21分的风险评分。
40例患者（8.9%）发生HF。HF风险评分包括基线GLS＞-15%（提示损伤更严重）（6分）、基线左心室射血分数＜50%、既往心血管疾病、急性髓系白血病（各4分）、蒽环类药物累积剂量≥250mg/m²（2分）以及年龄＞60岁（1分）。患者被分为低风险（评分0至6分）、中风险（评分7至13分）和高风险（评分14至21分）。低、中、高风险组HF的估计1年累积发生率分别为1.0%、13.6%和35.0%（p＜0.001）。HF风险评分也可预测全因死亡率（p＜0.001）。然而，在调整年龄和白血病类型后，只有GLS与全因死亡率显著相关（风险比：1.73；95%置信区间：1.30至2.31；p＜0.001）。
我们制定了一个基线风险评分来确定急性白血病患者HF的风险。需要进一步研究以确定这些发现的外部有效性。
