Abstract 13185: Incidence and Risk Factors of Acute Cardiovascular Complications After Hematopoietic Stem Cell Transplantation

Abstract

Introduction: Hematopoietic stem cell transplantation (HSCT) is associated with various cardiovascular (CV) complications. Due to the lack of recent large cohort studies, the incidence and clinical determinants of acute HSCT-related CV events are ill-defined. Methods: We conducted a multi-center observational study (University of Michigan and Rush University) of adult (≥18 years) patients who underwent autologous or allogeneic HSCT for malignant or non-malignant bone marrow disorders from 2005-2021. Data on demographics, pre-HSCT clinical characteristics, imaging, laboratory findings, and acute (<100 days post-HSCT) CV outcomes were collected through manual chart review. The primary outcome was defined as a composite of death from CV cause, non-fatal myocardial infarction, need for revascularization, new-onset heart failure (HF), new diagnosis of atrial fibrillation/flutter, or sustained ventricular tachycardia. Results: Of 4,262 included patients (mean age at HSCT 56±14 years; 59% male; 82% White), 161 (3.8%) patients experienced an acute CV event (153 events/1,000 person-years). Compared to patients without a CV event, those who developed a CV event were older, had greater burden of CV comorbidities including HF, more likely to be on antihypertensives, statins, and aspirin, and had higher B-type natriuretic peptide and lower high-density lipoprotein pre-HSCT (Table). Pre-HSCT ejection fraction and prior anthracycline exposure were not associated with acute CV events. Conclusions: In the largest cotemporary cohort of adult HSCT patients to date, acute CV events occurred in <5% of patients. Events were more common in older patients with CV comorbidities. highlighting the potential need for improving the pre-HSCT CV risk stratification. The major limitation of this study is the retrospective nature and accompanying selection bias. Future prospective studies should assess evidence-based strategies for risk-stratifying HSCT patients.