A New Scoring System for the Evaluation of Ibrutinib-Associated Arrhythmias in CLL: ACEF.

Abstract

Bruton's tyrosine kinase (BTK) inhibition in cardiac tissue causes inhibition of the PI3K-AKT signaling pathway, which is responsible for protecting cardiac tissue during stress. Therefore, there is an increase in the risk of arrhythmia. This risk can be predicted with the Age-Creatinine-Ejection Fraction (ACEF) score, which is a simple scoring system that can be calculated from age, creatinine and ejection fraction components. Patients diagnosed with Chronic Lymphocytic Leukemia (CLL) and receiving Ibrutinib treatment for at least 1 year were evaluated with echocardiography and holter electrocardiography, and the results were compared with the control group of CLL patients who did not receive treatment. When arrhythmia development of the patients was evaluated, no statistically significant difference was found between the control and Ibrutinib groups in terms of other types of arrhythmias exact Paroxismal Atrial Fibrillation (PAF). PAF was found to be 8% versus 22% (p-value: 0.042) in the Ibrutinib non-users and users groups. In patients receiving ibrutinib, ACEF score of >1.21 predicted the development of PAF with 77% sensitivity and 75% specificity (Receiver Operating Characteristic [ROC] area under curve: 0.830, 95% CI: 0.698-0.962, P<0.001). The ACEF risk score can be used as a risk score that predicts the development of PAF in patients diagnosed with CLL and planned to start ibrutinib.