Monitoring of the very early changes of left ventricular diastolic function in patients with acute leukemia treated with anthracyclines

Pudil R., Horacek J.M., Strasova A., Jebavy L., Vojacek J.

To analyze the very early changes of diastolic LV function during and after chemotherapy (CT) in patients with newly diagnosed acute leukemia. Methods: 26 patients with acute leukemia have been studied. The cardiac echo evaluation was performed at the baseline (before CT), after the first CT (mean cumulative anthracyclines dose 136.3 ± 28.3 mg m–2), after the last CT (mean cumulative anthracyclines dose 464.3 ± 117.5 mg m–2) and circa 6 months after the completion of CT. Results: We found a significant decrease in LVEF (65.3 ± 4.5% vs 60.2 ± 5.7%, p < 0.01), the fractional shortening of the LV (34.8 ± 3.7%, vs 29.5 ± 5.0%, p < 0.01), but the mitral flow rapid filling velocity (E-wave) was not changed (0.74 ± 0.18 ms–1, vs 0.67 ± 0.17 ms–1, p ns), and atrial filling velocity (A-wave) increased (0.66 ± 0.15 ms–1 vs 0.78 ± 0.18 ms–1, p < 0.01). E/A ratio significantly decreased (1.18 ± 0.35 vs 0.89 ± 0.27, p < 0.01). IVRT increased (71.5 ± 11.6 ms vs 84.0 ± 11.6 ms, p < 0.01). DT E-wave velocity increased (162.3 ± 25.8 ms vs 206.7 ± 25.5 ms, p < 0.01). After the first CT, the signs of LV diastolic dysfunction were detected in 5 (19.2%) patients. 6 months after the last CT, two of these patients (7.7%) developed LV systolic dysfunction with the clinical symptoms of heart failure. Six months after the last CT, 12 (46.2%) patients developed the signs of LV diastolic dysfunction. Conclusion: Chemotherapy can induce early changes of diastolic left ventricular function. We consider using Doppler echocardiography as the election tool not only for baseline cardiologic screening but also for the monitoring of the earliest subclinical signs of cardiotoxicity.

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