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Predictive parameters for cardiovascular events in patients affected by multiple myeloma treated with carfilzomib

Session Poster session 2

Speaker Giulia Bruno

Event : EuroEcho 2018

  • Topic : imaging
  • Sub-topic : Echocardiography, Other
  • Session type : Poster Session

Authors : G Bruno (Turin,IT), I Maffei (Turin,IT), A Iannaccone (Turin,IT), T Crea (Turin,IT), M Salvini (Turin,IT), F Gay (Turin,IT), S Bringhen (Turin,IT), F Veglio (Turin,IT), A Milan (Turin,IT)

G Bruno1 , I Maffei1 , A Iannaccone1 , T Crea1 , M Salvini2 , F Gay2 , S Bringhen2 , F Veglio1 , A Milan1 , 1Hospital 'Città della Salute e della Scienza di Torino', Department of Medical Sciences - Turin - Italy , 2Hospital 'Città della Salute e della Scienza di Torino', Department of Haematology - Turin - Italy ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 1 ), i523

Background Carfilzomib is a second-generation proteasom inhibitor approved for the treatment of multiple myeloma (MM). Previous studies have demonstrated it improves the overall rate response and progression free survival in MM patients compared to other chemotherapeutic strategies. However, it seems to determine cardiovascular toxicity, first of all arterial hypertension. So far, no predictive factors for cardiovascular events (CVE) are known in patients affected by MM treated with carfilzomib.
Purpose Determine parameters able to predict CVE in MM patients undergoing carfizolmib infusions.
Methods From June 2016 to March 2018, 70 patients affected by MM were prospectively enrolled. A comprehensive cardiovascular evaluation was performed in our EchoLab, where each patient underwent the measurement of office blood pressure values, an ambulatory blood pressure monitoring (ABPM), a transthoracic echocardiogram, the assessment of carotid-femoral pulse wave velocity (cf-PWV). Antihypertensive treatment adjustment was performed when needed. Patients were able to start carfilzomib infusions if office blood pressure values were < 140/90 mmHg and they were followed up to determine the incidence of CVE during and after treatment.
Results Mean age was 60.3±8.2, 51% were male. 37% had arterial hypertension. Mean MM duration was 4.3±3.6 years and 90% of our patients had received previous chemotherapy. Mean office blood pressure and ABPM values were within normal limits as well as baseline echocardiographic parameters and cf-PWV. The patients were followed up (FU) for 9.3[4.3;20.4] months after the beginning of carfilzomib treatment.  33% experienced CVE, 91% of them had uncontrolled hypertension, 4.5% had acute coronary syndrome and 4.5% had cardiac arrhythmias. Only 7% of the overall cohort had CVE with a severity score=3. We compared patients with and without CVE during FU: there were no differences in age, sex, anthropometric parameters, cardiovascular risk factors, oncological history and carfilzomib total dose between the two groups. We found that the group that experienced CVE had significantly higher baseline blood pressure values, left ventricular mass (98±23 vs 85±17g/m2, p=0.01) and cf-PWV (8.5±1.7 vs 7.5±1.6m/s, p=0.02) compared to the other. Furthermore, baseline uncontrolled blood pressure, left ventricular hypertrophy and cf-PWV=9 m/s were able to identify patients at higher risk of developing CVE after carfilzomib infusions.
Conclusion Blood pressure control, left ventricular mass and cf-PWV may predict CVE in MM patients treated with carfilzomib.

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