Use of CMR in the assessment of cardiovascular reserve in patients treated with CAR-T therapy

Abstract Introduction Patients eligible for CAR-T cell therapy face a significant risk of impaired cardiovascular reserve due to prior exposure to multiple lines of potentially cardiotoxic treatments, the need for additional conditioning chemotherapy, and the presence of pre-existing cardiovascular disease (CVD) and comorbidities. While cardiovascular magnetic resonance (CMR) is the gold standard for assessing cardiac volumes, systolic function, and tissue characterization, its role in the baseline evaluation of these patients remains underexplored. Additionally, evidence suggests that up to 25% of CAR-T therapy recipients may develop cardiovascular complications. Purpose To assess the baseline cardiovascular reserve of patients eligible for CAR-T cell therapy using CMR. Methods A prospective, descriptive, and non-interventional single-centre study included the first 100 patients treated with CAR-T therapy including a comprehensive cardiovascular evaluation incorporating CMR was performed. Epidemiological variables, cardiovascular risk factors (CVRFs), cardiac history, cardiac biomarkers and imaging parameters from CMR were collected. Statistical analyses were conducted using SPSS version 27. Results The mean age was 58±12 years, with a predominance of male patients (61%). At least one CVRF was present in 66% of patients, with a calculated SCORE 2/2OP of 5±3%. The most prevalent CVRFs were hypertension (42%) and overweight/obesity (56%). Pre-existing CVD was found in 20% (arrhythmias 13%, cardiotoxicity 10%, ischemic heart disease 9%) and 60% were under cardiovascular treatment. Other comorbidities included venous thromboembolic disease (14%) and chronic kidney disease (9%). Baseline assessment revealed poor CVRF control in 54% of patients, a new CVD diagnosis in 26% and cardiovascular treatment adjustments in 33%. Regarding biomarkers, NT-proBNP was elevated in 51% and troponin in 22%. CMR could be performed in 84 patients, identifying left ventricular systolic dysfunction in 8.3%, right ventricular systolic dysfunction in 1.2%, left ventricular dilatation in 1.2%, right ventricular dilatation in 1.2% and late gadolinium enhancement in 14.3% (36% transmural, 50% without previous ischemic heart disease). Conclusion Patients eligible for CAR-T therapy have a high cardiovascular risk. A comprehensive baseline cardiovascular assessment, including biomarkers and CMR, allows for the identification of previously undiagnosed CVD and CVRFs, enabling optimization of cardiovascular treatment. This approach may potentially reduce the risk of cardiovascular complications during and after CAR-T therapy.Baseline sample characteristics