Author + information
- Yu Kang, MD, PhDa,∗,
- Bruna Leal Assuncao, MDb,∗,
- Srinivas Denduluri, PhDa,
- Shannon McCurdy, MDc,
- Selina Luger, MDc,
- Bénédicte Lefebvre, MDa,
- Joseph Carver, MDa,d and
- Marielle Scherrer-Crosbie, MD, PhDa,∗ (, )@mariellesc1
- aDivision of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bDepartamento de Medicina, Universidade Federal de Sao Paulo, UNIFESP, Sao Paulo-SP, Brazil
- cDivision of Hematology and Oncology Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- dAbramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Marielle Scherrer-Crosbie, Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives The purpose of this study was to investigate the occurrence and develop a risk score for heart failure (HF) in acute leukemia.
Background Knowledge is scarce regarding the incidence and risk factors of symptomatic HF in patients with acute leukemia.
Methods 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.
Results 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/m2 (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).
Conclusions 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.
↵∗ Drs. Kang and Assuncao contributed equally to this work.
The study was funded by the National Heart, Lung, and Blood Institute 1R01HL130539–01 (to MSC). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The study was partially presented as a poster at the American Heart Association Scientific Meeting, November 2018, Chicago, Illinois. Dr. Anju Nohria, MD, served as Guest Editor-in-Chief and Dr. Khurram Nasir, MD, served as Guest Editor for this paper.
- Received June 3, 2019.
- Revision received October 2, 2019.
- Accepted October 16, 2019.
- 2019 The Authors