Two-dimensional speckle-tracking strain detects subclinical cardiotoxicity in older patients treated for acute myeloid leukemia

Gregory J. Cascino, Woo Bin Voss, Jonathan Canaani, Nicholas Furiasse, Alfred Rademaker, Bonnie Ky, Selina Luger, Jessica K. Altman, James M. Foran, Mark R. Litzow, Martin S. Tallman, Vera Rigolin, Nausheen Akhter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Patients with acute myeloid leukemia (AML) are surviving longer. There are no data on changes in myocardial mechanics from standard of care low-dose anthracycline-based induction chemotherapy in older patients with AML. The aim of this study was to demonstrate the potential utility of strain imaging in detecting early changes in left ventricular function in this patient population after induction chemotherapy. Methods: Thirty two patients enrolled in the ECOG-ACRIN E2906 study (cytarabine and daunorubicin vs clofarabine [Genzyme/Sanofi]) from 2011 to 2014 were evaluated retrospectively. Two-dimensional transthoracic echocardiography (TTE) imaging with Doppler and two-dimensional speckle-tracking echocardiography (2DSTE) using EchoInsight software (Epsilon imaging) were performed before and after induction chemotherapy. Results: Eighteen patients received cytarabine and daunorubicin (7 + 3) and 14 received clofarabine. The clofarabine group was older than the 7 + 3 cohort (67.8 ± 4.0 vs 63.7 ± 3.8, P =.007). There were no other significant differences in cardiac risk factors between groups. The 7 + 3 group had a decrease in average peak systolic global longitudinal (−19.1 ± 2.8 to −17.2 ± 3.0, P =.01) and circumferential strain (−29.4 ± 6.3 to −23.9 ± 4.3, P =.011). These changes were not demonstrated in the clofarabine group and were not associated with a decline in left ventricular ejection fraction (LVEF). Conclusions: In older AML patients, standard cytarabine and daunorubicin chemotherapy causes early changes in global longitudinal and circumferential strain not seen with clofarabine therapy. These findings demonstrate subclinical left ventricular dysfunction after exposure to low cumulative doses of anthracycline-based induction chemotherapy and may help us better identify those patients at risk for adverse long-term cardiovascular outcomes.

Original languageEnglish
Pages (from-to)2033-2040
Number of pages8
JournalEchocardiography
Volume36
Issue number11
DOIs
StatePublished - 1 Nov 2019

Funding

FundersFunder number
ECOG‐ACRIN Cancer Research Group
US government
National Institutes of HealthCA180820, CA180791, CA180794, CA180790
Foundation for the National Institutes of Health
National Cancer InstituteUG1CA233290

    Keywords

    • acute myeloid leukemia
    • anthracyclines
    • cardiotoxicity
    • left ventricular function
    • two-dimensional speckle-tracking strain

    Fingerprint

    Dive into the research topics of 'Two-dimensional speckle-tracking strain detects subclinical cardiotoxicity in older patients treated for acute myeloid leukemia'. Together they form a unique fingerprint.

    Cite this