Aghel Nazanin, Wang Vincent, Leong Darryl, Lui Michelle, Fu Livia, Kang Jasmine, Khalaf Dina, Walker Irwin, Hillis Christopher, Leber Brian, Klimis Harry, Holbrook Anne, Demers Catherine, Joseph Philip, Lepic Kylie, Garcia-Horton Alejandro, Berg Tobias, Lipton Jeffrey Howard, Duong Mylinh, Turner Jane, Ma Jinhui
Division of Cardiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada.
Hamilton Health Sciences, Hamilton, Ontario, Canada.
JACC Adv. 2025 Jun;4(6 Pt 1):101760. doi: 10.1016/j.jacadv.2025.101760. Epub 2025 May 22.
Allogeneic hematopoietic stem cell transplantation (HSCT) is associated with organ toxicities, including cardiovascular (CV) complications. Data on contemporary acute postallogeneic HSCT cardiac complications and their impact on survival are scant.
The aim of the study was to determine the incidence of early CV events following allogeneic HSCT and their effect on survival within the first 100 days.
We conducted a single-center retrospective cohort study of adult patients who underwent allogeneic HSCT between 2004 and 2022. CV outcomes were a composite of CV death, myocardial infarction, heart failure, arrhythmia, stroke, or transient ischemic attack in early (≤100 days) postallogeneic HSCT.
The 100-day cumulative incidences of CV events in 852 patients (median age: 54 years; 58.57% male) was 5.55% (95% CI: 4.13%-7.26%). The most frequent cardiac event was atrial arrhythmia (cumulative incidence: 3.92% [95% CI: 2.84%-5.56%]), followed by heart failure (cumulative incidence: 2.07% [95% CI: 1.26%-3.24%]). Age (subhazard ratio [SHR] per year: 1.07; 95% CI: 1.03-1.13) and left ventricular ejection fraction <50% before transplant (SHR: 3.16; 95% CI: 1.43-6.98) were independently associated with increased risk of CV events. Nonfatal CV events during the first 100 days were independently associated with an increased hazard of nonrelapse mortality (SHR: 6.25; 95% CI: 2.83-13.79) and all-cause mortality (HR: 5.79; 95% CI: 2.87-11.68).
Although CV events are relatively uncommon in the first 100 days in patients after allogeneic HSCT, the occurrence of CV events is associated with high nonrelapse and all-cause mortality rates. Close monitoring of patients who develop CV events is recommended.
异基因造血干细胞移植（HSCT）与器官毒性相关，包括心血管（CV）并发症。关于当代异基因HSCT后急性心脏并发症及其对生存影响的数据很少。
本研究的目的是确定异基因HSCT后早期CV事件的发生率及其对前100天内生存的影响。
我们对2004年至2022年间接受异基因HSCT的成年患者进行了一项单中心回顾性队列研究。CV结局是异基因HSCT后早期（≤100天）CV死亡、心肌梗死、心力衰竭、心律失常、中风或短暂性脑缺血发作的综合结果。
852例患者（中位年龄：54岁；58.57%为男性）100天CV事件累积发生率为5.55%（95%CI：4.13%-7.26%）。最常见的心脏事件是房性心律失常（累积发生率：3.92%[95%CI：2.84%-5.56%]），其次是心力衰竭（累积发生率：2.07%[95%CI：1.26%-3.24%]）。年龄（每年亚危险比[SHR]：1.07；95%CI：1.03-1.13）和移植前左心室射血分数<50%（SHR：3.16；95%CI：1.43-6.98）与CV事件风险增加独立相关。前100天内的非致命CV事件与非复发死亡率增加（SHR：6.25；95%CI：2.83-13.79）和全因死亡率增加（HR：5.79；95%CI：2.87-11.68）独立相关。
尽管异基因HSCT后患者在前100天内CV事件相对不常见，但CV事件的发生与高非复发和全因死亡率相关。建议密切监测发生CV事件的患者。
