Lazar Diana R, Maniu Dana, Lazar Florin-Leontin, Blag Cristina, Bota Madalina, Zdrenghea Mihnea, Cainap Simona
Department No. 10, Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 400012, Romania.
Department of Pediatric Cardiology, Emergency Clinical Hospital for Children, Cluj-Napoca, 400394, Romania.
Ann Hematol. 2025 Aug;104(8):4157-4164. doi: 10.1007/s00277-025-06523-7. Epub 2025 Jul 30.
Childhood leukemia survivors are at a lifelong risk of cardiac dysfunction due to anthracycline treatment. This study is among the first to assess pre-chemotherapy cardiac abnormalities in children newly diagnosed with acute lymphoblastic leukemia (ALL), aiming to identify early indicators of cardiac dysfunction before anthracycline exposure. Existing literature largely focuses on cardiac damage following chemotherapy, but our findings suggest that subclinical cardiac changes may already be present at diagnosis. The cohort included 47 children diagnosed with ALL, none of whom presented clinical signs of cardiac disease. A baseline cardiac evaluation was performed before the onset of chemotherapy. Our findings demonstrated that 29.78% of patients had elevated hs-Troponin and 44.68% had elevated NT-proBNP levels before chemotherapy, with patients in the high relapse risk group (HRG) presenting significantly increased rates of abnormal values. Also, ECG abnormalities, including abnormal heart rate and PR interval, were more frequent in this group. Echocardiography revealed higher LV mass index and more diastolic dysfunction in the HRG compared to the intermediate-risk group. What is more, female patients showed greater baseline cardiac vulnerability, and younger children had proportionally higher indexed LV mass despite lower absolute LV mass. These results suggest that cancer itself may influence cardiac function before chemotherapy, potentially predisposing pediatric patients to long-term cardiac dysfunction.
由于蒽环类药物治疗，儿童白血病幸存者终生面临心脏功能障碍的风险。本研究是首批评估新诊断为急性淋巴细胞白血病（ALL）的儿童化疗前心脏异常情况的研究之一，旨在在蒽环类药物暴露前确定心脏功能障碍的早期指标。现有文献主要关注化疗后的心脏损伤，但我们的研究结果表明，在诊断时可能已经存在亚临床心脏变化。该队列包括47名诊断为ALL的儿童，他们均未出现心脏病的临床症状。在化疗开始前进行了基线心脏评估。我们的研究结果表明，29.78%的患者化疗前高敏肌钙蛋白升高，44.68%的患者NT-proBNP水平升高，高复发风险组（HRG）患者异常值的发生率显著增加。此外，该组心电图异常（包括心率和PR间期异常）更为常见。超声心动图显示，与中危组相比，HRG组左心室质量指数更高，舒张功能障碍更明显。此外，女性患者表现出更大的基线心脏易损性，年龄较小的儿童尽管绝对左心室质量较低，但左心室质量指数成比例地更高。这些结果表明，癌症本身可能在化疗前影响心脏功能，可能使儿科患者易患长期心脏功能障碍。
