Predictors of cardiovascular events and all-cause of death in patients with transfusion-dependent myelodysplastic syndrome

Cardiovascular disease (CVD) involves the second cause of death in low-risk myelodysplastic syndrome (MDS) population. Prospective study to characterise the CVD and to identify predictors for the combined event (CE) cardiovascular event and/or all-cause mortality in transfusion dependent low-risk MDS patients. Thirty-one patients underwent a cardiac assessment including biomarkers and cardiac magnetic resonance (cMR) with parametric sequences (T1, T2 and T2* mapping) and myocardial deformation by feature tracking (FT) and were analysed for clonal hematopoiesis of indeterminate potential mutations. Cardiac assessment revealed high prevalence of unknown structural heart disease (51% cMR pathological findings). After 2 center dot 2 [0 center dot 44] years follow-up, 35 center dot 5% of patients suffered the CE: 16% death, 29% cardiovascular event. At multivariate analysis elevated NT-proBNP >= 486pg/ml (HR 96 center dot 7; 95%-CI 1 center dot 135-8243; P = 0 center dot 044), reduced native T1 time < 983ms (HR 44 center dot 8; 95%-CI 1 center dot 235-1623; P = 0 center dot 038) and higher left ventricular global longitudinal strain (LV-GLS) (HR 0 center dot 4; 95%-CI 0 center dot 196-0 center dot 973; P = 0 center dot 043) showed an independent prognostic value. These variables, together with the myocardial T2* time < 20ms, showed an additive prognostic value (Log Rank: 12 center dot 4; P = 0 center dot 001). In conclusion, low-risk MDS patients frequently suffer CVD. NT-proBNP value, native T1 relaxation time and longitudinal strain by FT are independent predictors of poor cardiovascular prognosis, thus, their determination would identify high-risk patients who could benefit from a cardiac treatment and follow-up.