Prediction of heart failure in leukemia

Prediction of heart failure in leukemia

Researchers have developed a twenty one point score to predict the development of heart failure in acute leukemia patients treated with anthracyclines [1]. They obtained baseline echocardiographic measurements including left ventricular ejection fraction and global longitudinal strain in 450 acute leukemia patients treated with anthracyclines. A 21 point risk score was generated by evaluating potential risk factors for heart failure using Fine and Gray’s regression analysis.

Six variables were selected based on their statistical significance and clinical relevance (assigned score points for each in brackets):

1. Age above 60 years (Score: 1)
2. Cumulative anthracycline dose of 250 mg per sq. m or more (Score: 2)
3. Presence of acute myeloid leukemia (Score: 4)
4. Pre-existing cardiovascular disease (Score: 4)
5. Baseline left ventricular ejection fraction below 50% (Score: 4)
6. Global longitudinal strain more than -15% (Score: 6)

Sum of scores for each patient was calculated and the cumulative score would range from 0 to 21. They were further subclassified into three risk groups (one year cumulative heart failure risk in brackets):

1. Low risk: Score 0-6 (Cumulative heart failure risk: 1%)
2. Moderate risk: Score 7-13 (Cumulative heart failure risk: 13.6%)
3. High risk: Score 14-21 (Cumulative heart failure risk: 35%)

The heart failure risk score was also predictive of all cause mortality. Among the individual parameters, after adjustment for age and type of leukemia (acute myeloid leukemia), only global longitudinal strain was significantly associated with all cause mortality.

Reference

1. Kang Y, Assuncao BL, Denduluri S, McCurdy S, Luger S, Lefebvre B, Carver J, Scherrer-Crosbie M. Symptomatic Heart Failure in Acute Leukemia Patients Treated With Anthracyclines. J Am Coll Cardiol CardioOnc. 2019;1(2):208–17.