Key result
Relevant prior cardiac disease increased the risk of fatal cardiac events in newly diagnosed AML patients, with a 4.6% overall crude incidence of fatal events.
Why the study?
The incidence of cardiac morbimortality in acute myeloid leukemia is not well known.
What is the incidence of fatal and non-fatal cardiac events and what risk factors (such as prior cardiac disease) predict their occurrence in adult patients with newly diagnosed acute myeloid leukemia?
Cohort (n=571)
No
What is the incidence of fatal and non-fatal cardiac events and what risk factors (such as prior cardiac disease) predict their occurrence in adult patients with newly diagnosed acute myeloid leukemia?
Answers are grounded in this paper and cite their sources.
Adult patients with newly diagnosed AML experience a very high cumulative incidence of non-fatal (56.9% at 9 years) and fatal (6.7% at 9 years in treated patients) cardiac events, with prior cardiac disease increasing the hazard of fatal cardiotoxicity nearly seven-fold and grade 3-4 events significantly reducing overall survival.
The incidence of cardiac morbimortality in acute myeloid leukemia (AML) is not well known. We aim to estimate the cumulative incidence (CI) of cardiac events in AML patients and to identify risk factors for their occurrence. Among 571 newly diagnosed AML patients, 26 (4.6%) developed fatal cardiac events, and among 525 treated patients, 19 (3.6%) experienced fatal cardiac events (CI: 2% at 6 months; 6.7% at 9 years). Prior heart disease was associated with the development of fatal cardiac events (hazard ratio (HR) = 6.9). The CI of non-fatal cardiac events was 43.7% at 6 months and 56.9% at 9 years. Age ≥ 65 (HR = 2.2), relevant cardiac antecedents (HR = 1.4), and non-intensive chemotherapy (HR = 1.8) were associated with non-fatal cardiac events. The 9-year CI of grade 1–2 QTcF prolongation was 11.2%, grade 3 was 2.7%, and no patient had grade 4–5 events. The 9-year CI of grade 1–2 cardiac failure was 1.3%, grade 3–4 was 15%, and grade 5 was 2.1%; of grade 1–2, arrhythmia was 1.9%, grade 3–4 was 9.1%, and grade 5 was 1%. Among 285 intensive therapy patients, median overall survival decreased in those experiencing grade 3–4 cardiac events (p < 0.001). We observed a high incidence of cardiac toxicity associated with significant mortality in AML.
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Boluda et al. (2023) conducted a cohort in Newly diagnosed acute myeloid leukemia (AML) (n=571). Relevant cardiac antecedents (symptomatic heart failure, myocardial infarction, or ejection fraction < 50%) vs. No prior relevant cardiac antecedents was evaluated on Incidence of fatal cardiac events from primary diagnosis until last follow-up or death (HR 6.9, 95% CI 2.8-16.7, p=<0.001). Relevant prior cardiac disease increased the risk of fatal cardiac events in newly diagnosed AML patients, with a 4.6% overall crude incidence of fatal events.
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