title: A single-institution analysis of the utility of pre-induction ejection fraction measurement in patients newly diagnosed with acute myeloid leukemia.
abstract: Anthracyclines, a standard component of induction therapy for acute myeloid leukemia (AML) are known to be cardiotoxic. Existing evidence supporting routine baseline pre-induction cardiac function testing is limited. We conducted a retrospective analysis of 119 consecutive patients diagnosed with AML at our center from 2009 to 2012. In the 76 patients for whom induction chemotherapy was planned, baseline ejection fraction measurements were rarely abnormal (four cases), and in none of these abnormal cases did the result change management decisions. Awaiting LVEF evaluation results led to a delay in chemotherapy administration by a mean of approximately 2 days at significant additional costs to the healthcare system. Routine baseline ejection fraction measurement should be abandoned as it does not change management, results in treatment delay and unnecessary healthcare expenditures. More selective baseline testing, preferentially in patients in whom there is a clinical reason of cardiac disease, should be pursued.
authors.affiliation: The Ottawa Hospital and Department of Medicine, University of Ottawa , Ottawa, ON , Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Bryant
authors.forename: Dawn
authors.initials: D
authors.lastname: Sheppard
authors.forename: Mitchell
authors.initials: M
authors.lastname: Sabloff
authors.forename: Michelle
authors.initials: M
authors.lastname: Delbaere
authors.forename: Ronnen
authors.initials: R
authors.lastname: Maze
authors.forename: David
authors.initials: D
authors.lastname: Allan
authors.forename: Harold
authors.initials: H
authors.lastname: Atkins
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bence-Bruckler
authors.forename: Carolyn
authors.initials: C
authors.lastname: Faught
authors.forename: Lothar
authors.initials: L
authors.lastname: Huebsch
authors.forename: Jason
authors.initials: J
authors.lastname: Tay
authors.forename: Brent
authors.initials: B
authors.lastname: Zanke
authors.forename: Chris
authors.initials: C
authors.lastname: Bredeson
mesh_terms: D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D066126:Cardiotoxicity / Q000517:prevention & control; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume
chemical_list: D018943:Anthracyclines
keywords: Myeloid leukemias and dysplasias; acute myeloid leukemia; anthracyclines; cardiotoxicity; chemotherapeutic approaches