Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA.
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Eur J Haematol. 2024 Jan;112(1):102-110. doi: 10.1111/ejh.14088. Epub 2023 Aug 30.
Cardiovascular 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.
To determine the association of baseline GLS with adverse cardiovascular events in adults receiving CAR-T cell therapy.
Patients 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.
Among 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.
Lower GLS and higher mitral E/e' on a baseline echocardiogram were associated with higher risk for CEs in patients receiving CAR T-cell therapy.
嵌合抗原受体（CAR）T 细胞治疗后，心血管事件（包括心力衰竭和心律失常）日益受到关注。虽然整体纵向应变（GLS）已证明对其他癌症治疗相关心功能障碍具有预后价值，但对于 GLS 与 CAR-T 细胞治疗后不良心脏事件的相关性知之甚少。
确定基线 GLS 与接受 CAR-T 细胞治疗的成年人不良心血管事件的相关性。
回顾性确定了在接受 CAR-T 细胞治疗前 6 个月内进行过超声心动图检查的患者。通过病历回顾收集临床数据和心脏事件。离线分析超声心动图以获取 GLS、左心室射血分数和多普勒参数。多变量逻辑回归用于确定不良心血管事件与超声心动图参数之间的关系。
在 75 名接受 CAR-T 细胞治疗的患者（平均年龄 63.9 岁，34.7%为女性）中，9 名患者（12%）在治疗后 1 年内发生了心脏事件（CEs），包括心血管死亡、新发/恶化心力衰竭和新发/恶化心律失常。在单变量模型中，较高的基线 GLS（比值比 0.78[0.63，0.96]，p=0.021）与较低的 CEs 风险相关，而较高的基线二尖瓣 E/e'（比值比 1.40[1.08，1.81]，p=0.012）与较高的 CEs 风险相关。在校正年龄和 LDH 后，较高的基线 GLS（比值比 0.65[0.48-0.88]，p<.01）与较低的 CEs 风险相关，而较高的基线二尖瓣 E/e'（比值比 1.56[1.06，2.29]，p=0.024）与较高的 CEs 风险相关。
在接受 CAR-T 细胞治疗的患者中，基线超声心动图上较低的 GLS 和较高的二尖瓣 E/e'与 CEs 风险增加相关。
