Symptomatic Heart Failure in Acute Leukemia Patients Treated With Anthracyclines

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 anthracyctines, before chemotherapy initiation. Potential risk factors for HF were evaluated using Fine and Grays regression analysis, and from this, a 21-point risk score was generated. RESULTS Forty patients (8.9%) developed HF. The HF risk score induded a baseline GIS > -15% (indicative of greater impairment) (6 points), baseline left ventricular ejection fraction <50%, pre-existing cardiovascular disease, acute myeloid leukemia (4 points each), cumulative anthracyctine dose >= 250 mg/m(2) (2 points), and age >60 years (1 point). Patients were stratified into tow (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 tow-, 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. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.