Table 1.
Cardiac event details, including timing and management among 34 patients with acute myeloid leukemia treated with HMA and venetoclax, stratified by pretreatment EF
| Cardiac events | All patients with cardiac events | Patients with EF <50% | Patients with EF ≥50% |
|---|---|---|---|
| Patients with cardiac event, no. (%) | 34 (20) | 10 (31) | 24 (22) |
| Total number of cardiac events | 48 | 18 | 30 |
| Venetoclax cycle during cardiac event, no. (%) | |||
| 1 | 15 (44) | 5 (50) | 10 (42) |
| 2 | 9 (26) | 1 (10) | 8 (32) |
| 3 | 4 (12) | 1 (10) | 3 (13) |
| >Cycle 3 | 6 (18) | 3 (30) | 3 (13) |
| Cardiac event subtype, no. (%) | |||
| LVEF decrease | 10 (21) | 8 (44) | 2 (7) |
| Troponin elevation | 7 (15) | 4 (22) | 3 (10) |
| Presumed type II, anemia Hb<8 | 3/7 | 2/4 | 1/3 |
| Presumed type II, afib with RVR | 1/7 | 0/4 | 1/3 |
| Unexplained by other factors | 3/7 | 2/4 | 1/3 |
| Type I NSTEMI | 3 (6) | 1 (6) | 2 (7) |
| Worsening HFpEF by echo | 4 (8) | 0 (0) | 4 (12) |
| Cardiogenic pulmonary edema | 3 (6) | 0 (0) | 3 (10) |
| Atrial fibrillation with RVR | 8 (17) | 2 (11) | 6 (20) |
| Other symptomatic arrhythmia | 4 (8) | 2 (11) | 2 (7) |
| Worsening CAD | 1 (2) | 0 (0) | 1 (3) |
| Pericardial effusion/pericarditis | 3 (6) | 0 (0) | 3 (10) |
| Cardiopulmonary arrest | 2 (4) | 0 (0) | 2 (7) |
| Worsening RV dysfunction by echo | 3 (6) | 1 (6) | 2 (7) |
| Predisposing factors in patients with cardiac events | |||
| Prior cardiac history, no. (%) * | 23 (68) | 9 (90) | 14 (58) |
| Cardiovascular risk factors (no. of patients) | 30 (88) | 9 (90) | 21 (88) |
| subtype, no. | |||
| HTN | 22 | 5 | 17 |
| HLD | 15 | 6 | 9 |
| Diabetes mellitus | 12 | 2 | 10 |
| Obesity | 10 | 3 | 7 |
| Tobacco use | 7 | 3 | 4 |
| Management of cardiac event, no. (%) | |||
| Outpatient management | 4 (12) | 0 (0) | 4 (17) |
| Hospital ward admission | 21 (62) | 7 (70) | 14 (58) |
| ICU/CICU admission | 9 (27) | 3 (30) | 6 (25) |
| Initiation of new medication | 26 (77) | 8 (80) | 18 (75) |
| Procedural intervention | 2 (6) | 1 (10) | 1 (4) |
| Impact of cardiac events on AML therapy, no. (%) | |||
| Venetoclax + HMA discontinued | 7 (21) | 4 (40) | 3 (13) |
| Venetoclax + HMA interrupted | 9 (27) | 4 (40) | 5 (21) |
Note: because most (23/25) events were concurrent, denominators in Predisposing Factors, Management, and Impact sections are number of patients rather than number of events.
CAD, coronary artery disease; cardiogenic pulmonary edema, pulmonary edema seen on imaging, presumed cardiac source, without echo to confirm EF changes; CICU, cardiac intensive care unit; HLD, hyperlipidemia; HTN, hypertension; ICU, intensive care unit; NSTEMI, non-ST elevation myocardial infarction; other symptomatic arrhythmia, arrhythmia other than atrial fibrillation with RVR; RV, right ventricle; troponin elevation, changing troponins without ECG changes.
Prior cardiac disease by subtype: CAD (n = 10); atrial fibrillation/flutter (n = 9); HFrEF (n = 4); HFpEF (n = 7); aortic/mitral stenosis (n = 6); peripheral arterial disease (n = 1); pericarditis (n = 1); pulmonary edema (n=1).