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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

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Introduction: HF is a major cause of morbidity and mortality in AML patients. This study was designed as an external evaluation of a risk score to determine the risk of HF in patients treated with anthracyclines for AML. Methods: A validation cohort was composed of 204 consecutive patients with AML treated with anthracyclines. 2DSTE was performed using TomTec software to obtain baseline GLS values. LVEF was calculated using modified Simpson’s biplane method. HF hospitalizations were defined using standard clinical criteria. The HF risk score included a baseline GLS > - 15% (6 points), baseline LVEF<50% (4 points), pre-existing cardiovascular disease (4 points), anthracycline dose >/= 250 mg/m 2 (2 points), and age > 60 years (1 point). Patients were stratified into low (0 to 2 points), medium (3 to 9 points), and high risk (10 to 17 points). Statistical analysis was performed to evaluate event-free survival of the risk categories. Results: The average age of the cohort was 54 with an average risk score of 7 points. 55% of the patients were male. In total, 44 patients (21%) experienced a hospitalization for HF (median time to hospitalization 1 month) within the follow-up period (median 18 months). The observed incidence of HF by risk category was 14% (18 of 130) in the low, 31% (19 of 61) in medium, and 54% (7 of 13) in high risk group. The association between HF and the risk group category was highly significant (p = 0.001). Event-free survival by risk category (Figure 1) was also statistically significant (p = 0.05), with individuals in the high risk category having a reduced event-free survival. Conclusions: This is the first external validation study of a risk score for HF in AML patients. The risk score that we evaluated was successful at identifying patient who were at higher risk of hospitalization for HF. This may be a useful tool in clinical practice to counsel patients regarding the risk of HF after induction chemotherapy with anthracyclines.