Two-dimensional speckle-tracking strain detects subclinical cardiotoxicity in older patients treated for acute myeloid leukemia.

BACKGROUND: Patients with acute myeloid leukemia (AML) are surviving longer. There are no data on changes in myocardial mechanics from standard of care low-dose anthracycline-based induction chemotherapy in older patients with AML. The aim of this study was to demonstrate the potential utility of strain imaging in detecting early changes in left ventricular function in this patient population after induction chemotherapy. METHODS: Thirty two patients enrolled in the ECOG-ACRIN E2906 study (cytarabine and daunorubicin vs clofarabine [Genzyme/Sanofi]) from 2011 to 2014 were evaluated retrospectively. Two-dimensional transthoracic echocardiography (TTE) imaging with Doppler and two-dimensional speckle-tracking echocardiography (2DSTE) using EchoInsight software (Epsilon imaging) were performed before and after induction chemotherapy. RESULTS: Eighteen patients received cytarabine and daunorubicin (7 + 3) and 14 received clofarabine. The clofarabine group was older than the 7 + 3 cohort (67.8 ± 4.0 vs 63.7 ± 3.8, P = .007). There were no other significant differences in cardiac risk factors between groups. The 7 + 3 group had a decrease in average peak systolic global longitudinal (-19.1 ± 2.8 to -17.2 ± 3.0, P = .01) and circumferential strain (-29.4 ± 6.3 to -23.9 ± 4.3, P = .011). These changes were not demonstrated in the clofarabine group and were not associated with a decline in left ventricular ejection fraction (LVEF). CONCLUSIONS: In older AML patients, standard cytarabine and daunorubicin chemotherapy causes early changes in global longitudinal and circumferential strain not seen with clofarabine therapy. These findings demonstrate subclinical left ventricular dysfunction after exposure to low cumulative doses of anthracycline-based induction chemotherapy and may help us better identify those patients at risk for adverse long-term cardiovascular outcomes.

The Diagnostic and Prognostic Value of Echocardiographic Strain.

Importance: Myocardial deformation or strain by speckle-tracking echocardiography (STE) has become an established echocardiographic modality for the diagnostic and prognostic evaluation of cardiac dysfunction. Current literature supports the incremental value of strain in diagnosis, risk stratification, and prognostication of a multitude of cardiac disease states. Observations: Strain has been studied across the clinical spectrum from common to obscure pathologic conditions. This review presents the current literature evaluating characteristic strain patterns across this clinical spectrum, discusses prognostic implications, and provides a case series of classic strain polar maps, which are also known as bull's-eye plots. Conclusions and Relevance: Characteristic bull's-eye patterns can be used to guide patient evaluation and management.

Incidence and type of bleeding complications early and late after acute coronary syndrome admission in a New Zealand cohort (ANZACS-QI-7).

AIMS: Use of anti-thrombotic agents has reduced ischaemic events in acute coronary syndromes (ACS), but can increase the risk of bleeding. Identifying bleeding events using a consistent methodology from routinely collected national datasets would be useful. Our aims were to describe the incidence and types of bleeding in-hospital and post-discharge in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) cohort. METHODS: 3,666 consecutive patients admitted with ACS (2007-2010) were identified within the ANZACS-QI registry. A set of International Classification of Disease 10 (ICD-10) codes that identified bleeding events was developed. Anonymised linkage to national mortality and hospitalisation datasets was used to identify these bleeding events at the index admission and post-discharge. RESULTS: Three hundred and ninety-nine (10.8%) out of 3,666 patients had at least one bleeding event during a mean follow-up of 1.94 years. One hundred and sixty-one (4.4%) had a bleeding event during their index admission, and 271 (7.4%) patients were re-hospitalised with bleeding during follow-up. Sixty-one patients (37.9%) were transfused for bleeding in the index admission cohort, and 59 patients (21.8%) at a subsequent admission. Procedural bleeding was the most common event during the index admission, whereas gastrointestinal bleeding was the most common delayed bleeding presentation. CONCLUSION: One in ten ACS patients experienced a significant bleeding event within 2 years. The use of this ICD-10 bleeding definition in national ACS cohorts will facilitate the study of bleeding event incidence and type over time and between geographical regions, both nationally and internationally, and the impact of changes in anti-thrombotic therapy and interventional practice.