Myocardial strain is associated with adverse cardiac events in patients treated with chimeric antigen receptor (CAR) T‐cell therapy

Abstract

BackgroundCardiovascular events, including heart failure and arrhythmias, following chimeric antigen receptor (CAR) T‐cell therapy are increasingly recognized. Although global longitudinal strain (GLS) has demonstrated prognostic utility for other cancer therapy‐related cardiac dysfunction, less is known regarding the association of GLS with adverse cardiac events following CAR T‐cell therapy.ObjectivesTo determine the association of baseline GLS with adverse cardiovascular events in adults receiving CAR‐T cell therapy.MethodsPatients who had an echocardiogram within 6 months prior to receiving CAR T‐cell therapy were retrospectively identified. Clinical data and cardiac events were collected via chart review. Echocardiograms were analyzed offline for GLS, left ventricular ejection fraction, and Doppler parameters. Multivariable logistic regression was used to determine the association between adverse cardiovascular events and echocardiographic parameters.ResultsAmong 75 CAR T‐cell therapy patients (mean age 63.9, 34.7% female), nine patients (12%) experienced cardiac events (CEs) including cardiovascular death, new/worsening heart failure, and new/worsening arrhythmia within 1 year of treatment. In univariable models, higher baseline GLS (OR 0.78 [0.63, 0.96], p = .021) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.40 [1.08, 1.81], p = .012) was associated with a higher risk of CE. After adjusting for age and LDH, higher baseline GLS (OR 0.65 [0.48–0.88], p = <.01) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.56 [1.06, 2.29], p = .024) was associated with a higher risk of CE.ConclusionLower GLS and higher mitral E/e' on a baseline echocardiogram were associated with higher risk for CEs in patients receiving CAR T‐cell therapy.

Chimeric antigen receptor T‐cell therapy, where are we now and where are we heading for

“…Regarding CAR‐T‐cell therapy associated toxicities, besides CRS and CRES, increasing cardiovascular events (CEs) are recognized, including cardiovascular death, new/worsening heart failure, and new/worsening arrhythmia within 1 year of CAR‐T treatment, which could be fatal. Global longitudinal strain and mitral E/e' calculated from baseline echocardiogram test could effectively identify individuals with higher risk for CEs in patients receiving CAR‐T‐cell therapy 10 . BM tests are not routinely performed in patients undergoing CAR‐T‐cell therapy, except for those who have BM infiltration at baseline.…”