Exploring the baseline cardiac function and its correlation with risk stratification in children diagnosed with acute
Diana R Lazar1,2, Dana Maniu3, Florin-Leontin Lazar4
1Department No. 10, Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 400012, Romania.
Insights
Pediatric leukemia patients may have pre-existing cardiac issues before chemotherapy. Early cardiac screening in acute lymphoblastic leukemia (ALL) patients can identify risks before treatment.
Area of Science:
- Pediatric Oncology
- Cardiology
- Cardio-Oncology
Background:
- Childhood leukemia survivors face lifelong cardiac dysfunction risk from anthracyclines.
- Current research primarily examines cardiac damage post-chemotherapy.
- Subclinical cardiac changes may exist at diagnosis, prior to treatment.
Purpose of the Study:
- Assess pre-chemotherapy cardiac abnormalities in newly diagnosed acute lymphoblastic leukemia (ALL) patients.
- Identify early indicators of cardiac dysfunction before anthracycline exposure.
- Investigate the influence of cancer itself on cardiac function in pediatric patients.
Main Methods:
- Baseline cardiac evaluation in 47 newly diagnosed ALL children before chemotherapy.
- Biomarker analysis: elevated high-sensitivity troponin (hs-Troponin) and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
- Electrocardiogram (ECG) and echocardiography to assess cardiac structure and function.
Main Results:
- 29.78% had elevated hs-Troponin; 44.68% had elevated NT-proBNP pre-chemotherapy.
- High relapse risk group (HRG) showed significantly higher abnormal biomarker rates.
- HRG had more frequent ECG abnormalities, higher LV mass index, and diastolic dysfunction.
- Female patients and younger children exhibited greater baseline cardiac vulnerability.
Conclusions:
- Cardiac abnormalities may be present in pediatric ALL patients at diagnosis, independent of chemotherapy.
- Cancer and its risk stratification (e.g., HRG) appear to influence baseline cardiac function.
- Findings suggest a need for early cardiac assessment to mitigate long-term risks in pediatric cancer patients.
Abstract:
Childhood leukemia survivors are at a lifelong risk of cardiac dysfunction due to anthracycline treatment. This study is among the first to assess pre-chemotherapy cardiac abnormalities in children newly diagnosed with acute lymphoblastic leukemia (ALL), aiming to identify early indicators of cardiac dysfunction before anthracycline exposure. Existing literature largely focuses on cardiac damage following chemotherapy, but our findings suggest that subclinical cardiac changes may already be present at diagnosis. The cohort included 47 children diagnosed with ALL, none of whom presented clinical signs of cardiac disease. A baseline cardiac evaluation was performed before the onset of chemotherapy. Our findings demonstrated that 29.78% of patients had elevated hs-Troponin and 44.68% had elevated NT-proBNP levels before chemotherapy, with patients in the high relapse risk group (HRG) presenting significantly increased rates of abnormal values. Also, ECG abnormalities, including abnormal heart rate and PR interval, were more frequent in this group. Echocardiography revealed higher LV mass index and more diastolic dysfunction in the HRG compared to the intermediate-risk group. What is more, female patients showed greater baseline cardiac vulnerability, and younger children had proportionally higher indexed LV mass despite lower absolute LV mass. These results suggest that cancer itself may influence cardiac function before chemotherapy, potentially predisposing pediatric patients to long-term cardiac dysfunction.
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