Cardiovascular events during hospitalization in an unselected cohort of hematopoietic stem cell transplant recipients. ARCA TPH Registry

Abstract Background/Introduction The incidence of cardiovascular events (CVEs) in Hematopoietic stem cell transplant (HSCT) recipients remains an important cause of morbidity and mortality. HSCT has expanded in recent years to include older patients with more comorbidities, including cardiovascular risk factors. Purpose The aim of our study is to describe the incidence of cardiovascular events during hospitalization in an unselected cohort of hematopoietic stem cell transplant recipients at our center. Methods We conducted a single-center retrospective study of a cohort of consecutive hematopoietic stem cell transplant recipients from 2018 to 2022. We reviewed the incidence of CVEs during hospitalization. Demographic variables, cardiovascular risk factors, comorbidities, transplant type, hematologic disease type, chemotherapy treatment, baseline echocardiogram, laboratory tests, and other events during hospitalization and after one year were collected. Results A total of 394 patients were included, of whom 16.8% suffered CVEs during hospitalization. The median age was 58 ± 13 years, and 39.9% were female. Patients were stratified into autologous transplant (n 240) and allogenic transplant (n 152). Among patients who received autologous transplant, 7.1% developed heart failure, 4.6% atrial fibrillation, 2.1% ventricular dysfunction, and 1.7% pericardial disease. The occurrence of CVEs during hospitalization was significantly associated with preexisting hypertension (p=0.04), prior rheumatologic disease (p=0.02), increased filling pressures on baseline echocardiogram (p=0.04), higher creatinine levels during hospitalization (1.36 vs 1.72 mg/dl; p=0.01), acute kidney injury (p<0.01), lower hemoglobin levels during hospitalization (8.2 vs 7.6 g/dl; p=0.004), respiratory failure (p=0.047), and venous thrombosis (p=0.047). Among patients who received allogeneic transplants, 9.9% developed heart failure, 3.9% atrial fibrillation, 5.3% pericardial disease, 2.6% ventricular dysfunction, and 2% chest pain. Cardiovascular events were significantly associated with higher creatinine levels during hospitalization (1.18 vs 1.58 mg/dl; p<0.01), lower hemoglobin levels (7.31 vs 6.16 g/dl; p<0.01), acute kidney injury (11.8 vs 28%; p=0.04), and respiratory failure (12 vs 50%; p<0.01). Conclusion(s) The prevalence of cardiovascular events during hospitalization in hematopoietic stem cell transplant recipients is high, with heart failure and atrial fibrillation being the most frequent. In autologous transplants, cardiovascular events were significantly associated with preexisting hypertension and the development of more severe anemia, acute kidney injury, respiratory failure, and venous thrombosis during hospitalization. In allogeneic transplants, they were significantly associated with more severe anemia, acute kidney injury, and respiratory failure during hospitalization. Multidisciplinary team might be the key to prevention.