Evidence for non-infiltrative cardiomyopathy in acute leukaemia and lymphoma: A clinical and echocardiographic study

Abstract

Left ventricular function was assessed with echocardiography in 27 normal subjects and in 38 patients with acute leukaemia and lymphoma. Eighteen patients in the leukaemia-lymphoma group (47%) had left ventricular dysfunction before chemotherapy as suggested by a significantly (P < 0.001) abnormal end-systolic dimension and a low fractional shortening. Cardiac failure developed in 12 patients (32%): 3 patients with preleukaemia, 3 with acute myeloid leukaemia, and 1 with Hodgkin's disease had heart failure before cytotoxic therapy and 5 others developed it within 3 to 24 weeks after 75 to 920 mg daunorubicin. Cardiac failure in 5 of the 7 pre-daunorubicin cases was well controlled while all the 5 patients who developed left ventricular failure after daunorubicin died. In 3 of these the heart failure was the only cause of death. Necropsy in 4 patients showed no leukaenmic infiltration of the myocardium. Sequential echocardiograms showed a deterioration in left ventricular function during the first 6 months and a steady improvement in patients who lived longer than 9 months. This study shows that 47 per cent ofpatients with acute leukaenaia and lymphoma have non-infiltrative cardiomyopathy which is unrelated to drugs, and asignificant proportion of the sedevelop heart failure. This cardiomyopathy does not appear to be reversible though patients who survive longer than 9 months show some improvement in their left ventricular function. Cardiac failure also develops in some patients with normal left ventricular function. This and the deterioration in left ventricular function during the first 6 months in leukaemic patients may be caused by daunorubicin which is a potent antileukaemic drug.