Cardiac-Related Lesions in Newly Diagnosed Patients With Acute Leukemia: A Chinese Population-Based Real-World Study

Abstract

The relationship between newly diagnosed acute leukemia (AL) and heart-related lesions remains unclear. This study aimed to investigate baseline cardiac function and risk of cardiovascular diseases (CVDs) in patients with new-onset AL, and provide data on cardiac management strategies for patients with AL. We retrospectively collected data on baseline characteristics, echocardiography, and biochemical blood indicators (e.g., myocardial enzymes) from 408 patients, 200 with newly diagnosed AL, 103 with coronary artery disease (CAD), and 105 controls from January 1, 2015 to August 31, 2019. The creatine kinase isoenzyme myocardial band, lactate dehydrogenase, highly sensitive troponin-I, and B-type natriuretic peptide levels and left ventricular internal diameter (LVID) were significantly higher in patients with newly diagnosed AL than in the control group. The degree of cardiac damage was lower in newly diagnosed AL patients than in CAD patients. The best predictor of heart damage was LVID (AUC [area under the curve] = 0.709; 95% CI [confidence interval]: 0.637–0.781; p < 0.001), and independent prognostic risk factors were age and ejection fraction (HR [hazard ratio] = 1.636; 95% CI: 1.039–2.575; p = 0.033). The ratio of leukemia blasts among patients with AL was positively correlated with cardiac damage. Our data indicated that newly diagnosed AL patients had certain myocardial damage before treatment. Clinicians need to pay attention to these manifestations, which may be related to the prognosis.

Development of a risk assessment model for cardiac injury in patients newly diagnosed with acute myeloid leukemia based on a multicenter, real-world analysis in China

“…Xiao W et al found that newly diagnosed AL patients did experience some cardiac-related lesions prior to chemotherapy, and this injury persisted after adjusting for confounding factors. In addition, cardiac enzyme abnormalities were more severe in the hyperleukocytic leukemia subgroup (WBC count ≥ 100 × 10 9 /L), and the proportion of blasts was positively correlated with cardiac injury [ 20 ]. In agreement with our result, a retrospective study from Harvard Medical School also found that AL was associated with cardiac alterations before chemotherapy [ 27 ], which together with other similar studies [ 28 , 29 ], suggests that leukemia itself may cause direct damage to the heart prior to anti-tumor therapy.…”

“…Hence, it is postulated that leukemia per se induces some cardiac injury through the release of excessive cytokines or infiltration of leukemic cells, even before the administration of anti-tumor medications. Our team conducted a cardiac assessment of newly diagnosed AL patients in the Chinese population and found that the myocardial enzyme levels in AL patients were significantly higher than those in healthy controls [ 20 ]. Consequently, we intend to investigate additional hematological risk factors linked to cardiac injury in newly diagnosed AML patients, with the ultimate goal of constructing a prediction model that would assist hematologists in identifying varying levels of risk and offering precise treatment options for individual patients.…”