Leiva Orly, Jenkins Andrew, Rosovsky Rachel P, Leaf Rebecca Karp, Goodarzi Katayoon, Hobbs Gabriela
Division of Cardiovascular Medicine, Department of Medicine, New York University Langone Health, New York, NY, USA; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
J Cardiol. 2023 Mar;81(3):260-267. doi: 10.1016/j.jjcc.2022.10.007. Epub 2022 Oct 29.
Patients with myeloproliferative neoplasms (MPNs), essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF), have increased risk of cardiovascular (CV) disease. Atrial fibrillation (AF) is associated with adverse CV outcomes including arterial thrombosis, heart failure (HF), and CV death and coexists with MPN. Traditional risk scores (CHA2DS2-VASC and HAS-BLED) for estimating risks/benefits of anticoagulation to prevent thrombotic events in AF do not include MPN status. Therefore, we aimed to investigate CV outcomes in patients with MPN and AF and evaluate the predictive ability of traditional risk scores.
We conducted a single-center, retrospective cohort study of patients with MPN and AF. Primary outcome was composite of CV death and arterial thromboembolism; secondary outcomes were bleeding requiring emergency department visit or hospitalization, hospitalization for HF, and all-cause death. Multivariable competing-risk and Cox proportional hazards regression models were used to estimate risk of outcomes. Receiver operating characteristic (ROC) curve used to evaluate predictive ability of CHA2DS2-VASC and HAS-BLED of composite outcome and bleeding, respectively.
A total 142 patients was included (62 ET, 54 PV, 26 MF). Composite outcome, bleeding, HF hospitalization and all-cause death occurred in 39 %, 30 %, 34 %, and 48 %, of patients respectively. After multivariable modeling, MF was associated with increased risk of composite outcome (SHR 2.70, 95 % CI 1.38-5.27) and all-cause mortality (HR 9.77, 95 % CI 4.88-19.54) but not bleeding (SHR 1.19, 95 % CI 0.51-2.80) or HF admissions (SHR 0.57, 95 % CI 0.19-1.72). CHA2DS2-VASC and HAS-BLED were poor predictors of composite outcome (C-statistic 0.52, 95 % CI 0.43-0.62) and bleeding (C-statistic 0.49, 95 % CI 0.40-0.58), respectively.
In patients with MPN and AF, MF is associated with increased risk of CV death and arterial thrombosis and traditional risk scores do not accurately predict outcomes in this patient population. Further investigation is needed to refine risk scores in this patient population.
骨髓增殖性肿瘤（MPN）患者，包括原发性血小板增多症（ET）、真性红细胞增多症（PV）和骨髓纤维化（MF），患心血管（CV）疾病的风险增加。心房颤动（AF）与不良心血管结局相关，包括动脉血栓形成、心力衰竭（HF）和心血管死亡，且与MPN共存。用于评估房颤患者抗凝预防血栓形成事件的风险/益处的传统风险评分（CHA2DS2-VASC和HAS-BLED）未纳入MPN状态。因此，我们旨在研究MPN合并AF患者的心血管结局，并评估传统风险评分的预测能力。
我们对MPN合并AF患者进行了一项单中心回顾性队列研究。主要结局是心血管死亡和动脉血栓栓塞的复合结局；次要结局是需要急诊科就诊或住院治疗的出血、因心力衰竭住院和全因死亡。使用多变量竞争风险和Cox比例风险回归模型来估计结局风险。分别使用受试者工作特征（ROC）曲线评估CHA2DS2-VASC和HAS-BLED对复合结局和出血的预测能力。
共纳入142例患者（62例ET，54例PV，26例MF）。复合结局、出血、心力衰竭住院和全因死亡分别发生在39%、30%、34%和48%的患者中。多变量建模后，MF与复合结局风险增加（SHR 2.70，95%CI 1.38-5.27）和全因死亡率增加（HR 9.77，95%CI 4.88-19.54）相关，但与出血（SHR 1.19，95%CI 0.51-2.80）或心力衰竭入院（SHR 0.57，95%CI 0.19-1.72）无关。CHA2DS2-VASC和HAS-BLED分别对复合结局（C统计量0.52，95%CI 0.43-0.62）和出血（C统计量0.49，95%CI 0.40-0.58）的预测能力较差。
在MPN合并AF患者中，MF与心血管死亡和动脉血栓形成风险增加相关，传统风险评分不能准确预测该患者群体的结局。需要进一步研究以完善该患者群体的风险评分。
