Predictors of cardiovascular events and all‐cause of death in patients with transfusion‐dependent myelodysplastic syndrome

• Published in: British journal of haematology Vol. 195; no. 4; pp. 536 - 541
• Main Authors: Alonso‐Fernandez‐Gatta, Marta, Martin‐Garcia, Ana, Martin‐Garcia, Agustin C., Lopez‐Cadenas, Felix, Diaz‐Pelaez, Elena, Jimenez‐Solas, Tamara, Gonzalez‐Martinez, Teresa, Sanchez‐Pablo, Clara, Diez‐Campelo, Maria, Sanchez, Pedro L.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2021
• Subjects: Aged; Aged, 80 and over; Biomarkers; Blood Transfusion; cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cause of Death; Coronary artery disease; Death; feature tracking; Female; Follow-Up Studies; Heart diseases; Hematology; Humans; Iron Overload - etiology; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate analysis; Myelodysplastic syndrome; Myelodysplastic Syndromes - blood; Myelodysplastic Syndromes - complications; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; NT‐proBNP; Patients; Population studies; Prognosis; Prospective Studies; Risk; T1 mapping; Ventricle; feature tracking; cardiovascular disease; NT-proBNP; myelodysplastic syndrome; T1 mapping
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.17652

Summary Cardiovascular disease (CVD) involves the second cause of death in low‐risk myelodysplastic syndrome (MDS) population. Prospective study to characterise the CVD and to identify predictors for the combined event (CE) cardiovascular event and/or all‐cause mortality in transfusion dependent low‐risk MDS patients. Thirty‐one patients underwent a cardiac assessment including biomarkers and cardiac magnetic resonance (cMR) with parametric sequences (T1, T2 and T2* mapping) and myocardial deformation by feature tracking (FT) and were analysed for clonal hematopoiesis of indeterminate potential mutations. Cardiac assessment revealed high prevalence of unknown structural heart disease (51% cMR pathological findings). After 2·2 [0·44] years follow‐up, 35·5% of patients suffered the CE: 16% death, 29% cardiovascular event. At multivariate analysis elevated NT‐proBNP ≥ 486pg/ml (HR 96·7; 95%‐CI 1·135–8243; P = 0·044), reduced native T1 time < 983ms (HR 44·8; 95%‐CI 1·235–1623; P = 0·038) and higher left ventricular global longitudinal strain (LV‐GLS) (HR 0·4; 95%‐CI 0·196–0·973; P = 0·043) showed an independent prognostic value. These variables, together with the myocardial T2* time < 20ms, showed an additive prognostic value (Log Rank: 12·4; P = 0·001). In conclusion, low‐risk MDS patients frequently suffer CVD. NT‐proBNP value, native T1 relaxation time and longitudinal strain by FT are independent predictors of poor cardiovascular prognosis, thus, their determination would identify high‐risk patients who could benefit from a cardiac treatment and follow‐up.