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. 2018 Nov-Dec;32(6):1599-1607.
doi: 10.21873/invivo.11420.

The Assessment of Left Ventricle Function and Subclinical Atherosclerosis in Patients with Acute Myeloid Leukemia

Anda Militaru  1 , Adina Avram  1 , Anca Maria Cimpean  2 , Mircea Iurciuc  3 , Petru Matusz  4 , Daniel Lighezan  1 , Marius Militaru  5
Affiliations

The Assessment of Left Ventricle Function and Subclinical Atherosclerosis in Patients with Acute Myeloid Leukemia

Anda Militaru et al. In Vivo. 2018 Nov-Dec.

Abstract

Aim To assess the onset of early left ventricular (LV) systolic and diastolic function impairment and the subclinical atherosclerosis following chemotherapy in patients diagnosed with acute myeloid leukemia (AML).

Materials and methods: Thirty patients diagnosed with AML with no cardiac history, having LV ejection fraction (LVEF) >50%, were evaluated at baseline and 6 months after starting four cycles of chemotherapy. We measured LV function, global longitudinal strain and subclinical atherosclerosis markers: intima-media thickness (IMT), arterial stiffness aortic pulse wave velocity (PWVAo) and ankle-brachial index (ABI).

Results: LVEF had decreased at 6 months after treatment initialization (p<0.001), the same changes being observed for LV fraction shortening (p<0.001), mitral annular plane systolic excursion and S' wave (p<0.001 and p<0.05). Bilateral IMT and PWVAo significantly increased, 12 out of 30 patients (40%) had LVEF ≤50% after 6 months of chemotherapy, five of them receiving daunorubicin at more than 500 mg/m2/injection.

Conclusion: LV function is impaired after 6 months of chemotherapy, with early changes of subclinical atherosclerosis becoming evident.

Keywords: Chemotherapy; LV function; arterial stiffness; cardiotoxicity; myocardial dysfunction; subclinical atherosclerosis.

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Figures

Figure 1
Figure 1. Assessment of left ventricular ejection fraction (LVEF) (%) atbaseline (A) and at 6 months after chemotherapy initialization (B) in afemale patient with acute myeloid leukemia enrolled in our study. LVEFdecreased by 8% at 6 months after chemotherapy treatment.
Figure 2
Figure 2. Left ventricular ejection fraction (LVEF) (%) of patients withacute myeloid leukemia at baseline and 6 months after chemotherapyinitialization. The line represents the median value, the box representsthe interquartile range, and the bars represent the minimum andmaximum values. Points outside the boxplot represent outlier values.
Figure 3
Figure 3. Speckle tracking: Average global longitudinal strain (GLS-AVG)(%) of patients with acute myeloid leukemia at baseline and at 6 monthsafter chemotherapy initialization. The line represents the median value, thebox represents the interquartile range, and the bars represent the minimumand maximum values. Points outside the boxplot represent outlier values.
Figure 4
Figure 4. Speckle tracking: Global longitudinal strain (GLS) at baseline and at 6 months from chemotherapy initialization in a male patient withacute myeloid leukemia enrolled in our study. A, B: At the first determination, the values of the average GLS (GLS-AVG) (−24.5%) were within thenormal range. This shows that there were no changes in the structure and function of the left ventricle. C, D: After 6 months of chemotherapy, adecrease in the overall GLS-AVG (−18.0%) was noted. This shows that there had been changes in myocardial structure from baseline. GLS-LAX:GLS of apical long axis, GLS-A4C: GLS of apical 4 chambers, GLS-A2C: GLS of apical 2 chambers.
See this image and copyright information in PMC

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