Background: Patients with acute leukemia (AL) are at heightened risk of cardiovascular complications due to both disease-related and treatment-related factors. These complications include heart failure, arrhythmias, myocardial infarction, and thromboembolic events which may significantly impact morbidity and mortality. Objective: To identify the risk factors contributing to cardiovascular complications in patients with acute leukemia. Methods: This systematic review was conducted according to the PRISMA reporting guideline. Multiple databases including PubMed, Scopus, IEEE Xplore, the Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched for studies published between 2020 and 2024. Eligible studies included those analyzing cardiovascular risk factors in AL patients across various subtypes and treatment stages. A total of 75 studies were included following rigorous screening and critical appraisal using tools appropriate for different study designs. Results: The results showed that cardiovascular complications in AL patients are multifactorial including demographic factors (e.g., age, sex, BMI), comorbidities (e.g., hypertension, diabetes, dyslipidemia), treatment exposures (e.g., anthracyclines, tyrosine kinase inhibitors, hematopoietic stem cell transplantation, radiation), and genetic predispositions (e.g., somatic and germline variants). Cardiac biomarkers (e.g., troponins, BNP), imaging (strain echocardiography), and electrocardiogram (ECG) abnormalities were key factors in detecting early or subclinical damage. Complications occurred both during and years after treatment, especially in childhood and long-term survivors. Conclusions: Cardiovascular complications are prevalent, and serious consequences in AL patients necessitate a personalized, multidisciplinary approach to risk stratification and monitoring. Considering clinical, genetic, and biomarker data can improve early detection and preventive strategies, ultimately enhancing patient outcomes.
背景：急性白血病（AL）患者因疾病相关及治疗相关因素，心血管并发症风险显著增高。这些并发症包括心力衰竭、心律失常、心肌梗死及血栓栓塞事件，可能严重影响发病率和死亡率。目的：明确导致急性白血病患者心血管并发症的风险因素。方法：本系统综述遵循PRISMA报告指南进行。检索了包括PubMed、Scopus、IEEE Xplore、Cochrane Library、Web of Science、ProQuest及Google Scholar在内的多个数据库，收集2020年至2024年间发表的研究。纳入标准为分析不同亚型及治疗阶段AL患者心血管风险因素的研究。经严格筛选及采用适合不同研究设计的工具进行批判性评估后，共纳入75项研究。结果：研究显示AL患者心血管并发症具有多因素性，包括人口学因素（如年龄、性别、体重指数）、合并症（如高血压、糖尿病、血脂异常）、治疗暴露（如蒽环类药物、酪氨酸激酶抑制剂、造血干细胞移植、放射治疗）及遗传易感性（如体细胞与生殖系变异）。心脏生物标志物（如肌钙蛋白、脑钠肽）、影像学检查（应变超声心动图）及心电图异常是检测早期或亚临床损伤的关键因素。并发症可发生于治疗期间及治疗后数年，尤其在儿童期及长期生存者中更为显著。结论：心血管并发症在AL患者中普遍存在且后果严重，需要采用个性化、多学科协作的风险分层与监测策略。综合临床、遗传及生物标志物数据可提升早期检测与预防策略水平，最终改善患者预后。
肿瘤(癌症)患者之家