Exploring the baseline cardiac function and its correlation with risk stratification in children diagnosed with acute lymphoblastic leukemia

Abstract

Childhood leukemia survivors are at a lifelong risk of cardiac dysfunction due to anthracycline treatment. This study is among the first to assess pre-chemotherapy cardiac abnormalities in children newly diagnosed with acute lymphoblastic leukemia (ALL), aiming to identify early indicators of cardiac dysfunction before anthracycline exposure. Existing literature largely focuses on cardiac damage following chemotherapy, but our findings suggest that subclinical cardiac changes may already be present at diagnosis. The cohort included 47 children diagnosed with ALL, none of whom presented clinical signs of cardiac disease. A baseline cardiac evaluation was performed before the onset of chemotherapy. Our findings demonstrated that 29.78% of patients had elevated hs-Troponin and 44.68% had elevated NT-proBNP levels before chemotherapy, with patients in the high relapse risk group (HRG) presenting significantly increased rates of abnormal values. Also, ECG abnormalities, including abnormal heart rate and PR interval, were more frequent in this group. Echocardiography revealed higher LV mass index and more diastolic dysfunction in the HRG compared to the intermediate-risk group. What is more, female patients showed greater baseline cardiac vulnerability, and younger children had proportionally higher indexed LV mass despite lower absolute LV mass. These results suggest that cancer itself may influence cardiac function before chemotherapy, potentially predisposing pediatric patients to long-term cardiac dysfunction.