A Retrospective Study On Subclinical Cardiac Injury Secondary To Daunorubicin Treatment Of171 Children With Acute Leukemia

Objective: To investigate features and outcomes of subclinical cardiac injury induced by daunorubicin in 171 children diagnosed with acute lymphoblastic leukemia(ALL),and to explore the risk factors of subclinical cardiac injury induced by daunorubicin in children with ALL.Materials and Methods: 171 cases of ALL,the use of daunorubicin chemotherapy,no cardiac injury before chemotherapy,retrospective analysis of changes on electrocardiogram(ECG),echocardiography(UCG)and biomarkers of myocardial injury before and after daunorubicin chemotherapy,and take abnormal ECG or abnormal UCG or abnormal levels of serum biomarkers of myocardial injury as diagnostic indicator of subclinical cardiac injury.Sum up the features of abnormal ECG and abnormal UCG in ALL children receiving daunorubicin.To compare whether there is a statistically significant difference between the cardiotoxicity group and no cardiotoxicity group on these factors such as age,sex,risk grade of ALL,history of hypothyroidism and cumulative dose of daunorubicin.And the risk factors of subclinical cardiac injury after treatment with daunorubicin in pediatric ALL are analyzed by the regression analysis.Results: Among 171 patients,74 patients had subclinical cardiac injury,with an incidence of 43.27%.47 cases(27.5%)had abnormal ECG,and various abnormalities on ECG ranked from high to low: ST-T changes,sinus tachycardia or irregular,ventricular high voltage,changes of the electrocardiogram axis,prolonged Q-T interval,conduction block.31 cases(18.1%)had abnormal UCG,and various abnormalities on UCG ranked from high to low: pericardial effusion,left ventriclefullness or enlarged,widened pulmonary artery,valvular insufficiency,tachycardia.Only 9 patients(5.26%)showed elevated level of serum biomarkers of myocardial injury.The difference of subclinical cardiac injury between history of hypothyroidism and cumulative dose of daunorubicin was statistically significant(P<0.05).Further analysis showed that the cumulative dose of daunorubicin was an independent risk factor for subclinical cardiotoxicity(P<0.05).The correlations between other factors such as age,sex,risk grade of ALL,history of hypothyroidism and subclinical cardiac injury were not statistically significant(P>0.05).Conclusion: 1.The incidence of subclinical cardiac injury after daunorubicin chemotherapy is high,which mainly manifests as abnormal changes on ECG and UCG.2.Changes of ECG occur early during induction remission chemotherapy,which are transient,and most of them return to normal within 4-8 weeks.3.Changes of UCG usually occur during consolidation chemotherapy and interphase chemotherapy,which last long,a few patients get worsen.4.Age,sex,risk grade of ALL and hypothyroidism are not related with subclinical cardiac injury.While the cumulative dose of daunorubicin is related with subclinical cardiac injury,which is an dependent risk factor for subclinical cardiac injury.5.Early treatment with angitotensin converting enzyme inhibitor(ACEI)for symptomatic cardiotoxicity is helpful.