Jin Wenying, Yang Sen, Yu Chao, Zhu Tiangang, Jiang Qian
Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Pekin University People's Hospital, Beijing, China.
National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Institute of Hematology, Beijing, China.
Front Cardiovasc Med. 2022 Aug 9;9:960531. doi: 10.3389/fcvm.2022.960531. eCollection 2022.
Pulmonary hypertension (PH) is a rare but life-threatening adverse event (AE) of dasatinib, but the associated variables are not clear. This study aimed to explore the variables associated with PH by echocardiography in patients with chronic myeloid leukemia in the chronic phase (CML-CP) receiving dasatinib therapy.
Echocardiography was performed to estimate the probability of PH and pulmonary artery systolic pressure (PASP). Binary logistic analysis and Fine-Gray hazard model were used to identify the variables associated with PH by using cross-sectional and longitudinal data.
Among the 243 patients in the cross-sectional dataset, with a median dasatinib therapy duration of 27 months, 30 (12.3%) were classified as having a high probability of PH. Increasing age (OR = 1.7, = 0.002; OR = 1.5, = 0.003) and pericardial effusion (OR = 4.3, = 0.004; OR = 3.2, = 0.014) were significantly associated with a high probability of PH and PASP ≥ 40 mmHg, respectively. Among the 161 patients in the longitudinal dataset, the 3-year cumulative incidences of a high probability of PH and PASP ≥ 40 mmHg were 9.3% and 22.1%, respectively. Pericardial effusion (HR = 3.8, = 0.005) and cardiopulmonary comorbidities (HR = 3.2, = 0.021) were significantly associated with a high probability of PH; increasing age (HR = 1.5, < 0.001) and dasatinib as ≥ 3rd-line therapy ( = 0.032; 2nd-line 1st-line, HR = 2.0, = 0.200; ≥ 3rd-line 1st-line, HR = 3.4, = 0.047) were significantly associated with PASP ≥ 40 mmHg.
Increasing age, pericardial effusion, cardiopulmonary comorbidities, and dasatinib as ≥ 3rd-line TKI therapy were associated with PH in the patients with CML-CP on dasatinib therapy.
肺动脉高压（PH）是达沙替尼一种罕见但危及生命的不良事件（AE），但相关变量尚不清楚。本研究旨在通过超声心动图探索慢性期慢性髓性白血病（CML-CP）接受达沙替尼治疗患者中与PH相关的变量。
进行超声心动图检查以评估PH概率和肺动脉收缩压（PASP）。采用二元逻辑回归分析和Fine-Gray风险模型，利用横断面和纵向数据识别与PH相关的变量。
在横断面数据集中的243例患者中，达沙替尼治疗的中位持续时间为27个月，30例（12.3%）被归类为PH高概率患者。年龄增加（OR = 1.7，P = 0.002；OR = 1.5，P = 0.003）和心包积液（OR = 4.3，P = 0.004；OR = 3.2，P = 0.014）分别与PH高概率和PASP≥40 mmHg显著相关。在纵向数据集中的161例患者中，PH高概率和PASP≥40 mmHg的3年累积发生率分别为9.3%和22.1%。心包积液（HR = 3.8，P = 0.005）和心肺合并症（HR = 3.2，P = 0.021）与PH高概率显著相关；年龄增加（HR = 1.5，P < 0.001）和达沙替尼作为≥三线治疗（P = 0.032；二线vs一线，HR = 2.0，P = 0.200；≥三线vs一线，HR = 3.4，P = 0.047）与PASP≥40 mmHg显著相关。
年龄增加、心包积液、心肺合并症以及达沙替尼作为≥三线酪氨酸激酶抑制剂（TKI）治疗与接受达沙替尼治疗的CML-CP患者的PH相关。
