Risk score may predict HF in acute leukemia
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A baseline risk score predicted HF risk in patients with acute leukemia with factors such as left ventricular ejection fraction, anthracycline dose, age and preexisting CVD, according to a study published in JACC: CardioOncology.
“This is a very understudied population, patients with acute leukemia, because the prognosis has been rather poor, so providers were focusing on treating the acute leukemia rather than treating any comorbidities,” Marielle Scherrer-Crosbie, MD, PhD, director of the cardiac ultrasound laboratory and a professor of cardiovascular medicine at University of Pennsylvania Perelman School of Medicine, told Healio. “However, the treatments have considerably improved in the last decade, so the prognosis is improving. ... This study brings awareness that those patients are at high risk of cardiac events.”
Patients with leukemia
Yu Kang, MD, PhD, postdoctoral research fellow at University of Pennsylvania Perelman School of Medicine, and colleagues analyzed data from 450 patients (mean age, 51 years; 48% men) with newly diagnosed acute myeloid leukemia or acute lymphoblastic leukemia who were treated with anthracyclines before chemotherapy was initiated between January 2004 and April 2018.
Clinical and echocardiographic parameters were assessed, including LVEF and myocardial strain. Researchers also reviewed preexisting CV risk factors and CVDs. CVDs were defined as chronic HF, CAD, stroke/transient ischemic attack and atrial fibrillation, and risk factors included hypertension, obesity, diabetes and hypercholesterolemia. These risk factors were evaluated with Fine and Gray’s regression analysis, which was then used to develop a 21-point risk score.
“This [risk score] is important because it allows the provider to see whether his or her patient is at high risk, moderate risk or low risk of cardiovascular events,” Scherrer-Crosbie said in an interview.
Of the patients in the study, 8.9% developed symptomatic HF.
The baseline HF risk score included LVEF of less than 50%, global longitudinal strain greater than –15% (6 points), acute myeloid leukemia (4 points), preexisting CVD (4 points), older than 60 years (1 point) and a cumulative anthracycline dose of at least 250 mg/m2 (2 points) After risk scores were calculated, patients were categorized as low (0 to 6 points), moderate (7 to 13 points) or high risk (14 to 21 points).
The estimated 1-year cumulative incidence of HF was 1% for patients with low risk, 13.6% for those with moderate risk and 35% for patients with high risk (P < .001).
The risk score was also linked to all-cause death in exploratory analyses (HR = 1.36; 95% CI, 1.23-1.5). Only global longitudinal strain was associated with all-cause mortality after adjusting for leukemia type and age (HR = 1.73; 95% CI, 1.3-2.31).
Further research
“It’s important to validate the risk score in another cohort of patients. That’s the very first step,” Scherrer-Crosbie told Healio. “The other important research that is needed is to understand why those patients are at high risk of heart failure in particular and to take measures to try to decrease this risk of heart failure. There may be some either genetic predisposition or characteristics that goes with the acute leukemia itself that may predispose those patients. The way that the anthracycline treatment or other treatments are given may also be worked on to see if there is possibilities to decrease the rates of heart failure, and giving cardioprotective drugs is also a possibility, but this cannot be done until more research is done to prove their efficiency.”
Juan C. Lopez-Mattei, MD, multimodality imaging cardiologist, associate professor of cardiology and diagnostic imaging and co-director of the cardiac radiology service (cardiac CT and MRI) at The University of Texas MD Anderson Cancer Center, and colleagues wrote a related editorial, in which they said, “Anthracycline use in clinical practice in the setting of a low baseline LVEF is quite uncommon (baseline prevalence of LVEF < 53% was 7% in this cohort), and perhaps the inclusion of this covariate could be less useful in widespread clinical practice, but in tertiary centers with complex and selected cases, this may occur more often.” – by Darlene Dobkowski
For more information:
Marielle Scherrer-Crosbie, MD, PhD, can be reached at Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104; email: marielle.scherrer-crosbie@pennmedicine.upenn.edu; Twitter: @mariellesc1.
Disclosures: The study was funded by the NHLBI. The authors of the study and of the editorial report no relevant financial disclosures.
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