Early-Onset Myocardial and Vascular Toxicity in Childhood Acute Lymphoblastic Leukemia Survivors: The Predictive Value of the Right Heart

Purpose. Childhood acute lymphoblastic leukemia (ALL) survivors who underwent chemotherapy with anthracyclines have an increased cardiovascular risk. Few are data about right ventricle function (RV) in these patients. The aim of the study was to evaluate left and right cardiac chambers and vascular endothelial function in ALL survivors. Methods. We enrolled 54 ALL survivors and 37 healthy controls. All patients underwent auxological evaluation, blood pressure, biochemical parameters of endothelial dysfunction, flow-mediated dilatation (FMD) of the brachial artery, mean common carotid intima-media thickness (c-IMT), antero-posterior diameter of the infra-renal abdominal aorta (APAO), and echocardiographic assessment. Results. ALL subjects had significantly lower FMD (p = 0.0041), higher left (p = 0.0057) and right (p = 0.0021) TEI index as compared to controls. Tricuspid annular plane excursion (TAPSE) was 16.9 ± 1.2 mm vs 24.5 ± 3.7 mm, p < 0.0001. Cumulative anthracycline doses were related to TAPSE (r = 0.77, p < 0.001). The ROC curve analysis revealed that left and right TEI index, TAPSE, FMD showed significant association to ALL condition. TAPSE > 18 mm was the best discriminant rule to spot ALL patients (AUC: 0.966, p < 0.0001, sensibility: 100%, specificity: 89.2%). Conclusion. ALL survivors treated with anthracyclines demonstrated systo/diastolic alterations of the RV and reduced endothelial function compared with healthy controls. Although multimodality diagnostic is available, echocardiography plays pivotal role in everyday clinical practice. The early recognition of subclinical cardiac and vascular impairment is of utmost importance for the cardio-oncologist to implement strategies preventing overt cardiovascular disease.