Incidence, risk factors, and prognostic implications of hospitalizations for heart failure among patients with myeloproliferative neoplasms

Abstract

Myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF), are a group of chronic leukemias associated with increased risk of heart failure (HF). Despite a link between MPNs and HF, prognostic implications and risk factors for HF are not well characterized. We conducted a multicenter retrospective cohort of MPN patients with ≥ 1 transthoracic echocardiogram (TTE) without known HF. Backward stepwise logistic regression was utilized to identify risk factors for hospitalization for HF (HFH). For associations between HFH and all-cause mortality and MPN disease progression to secondary myelofibrosis (MF) or acute leukemia, multivariable Cox proportional hazards and competing-risk regression were performed, respectively. Of 546 included patients (42.7% PV, 34.8% ET, and 22.5% MF), 50.5% were female, and 85 patients had HFH. Proportion of MPN types and driver mutations was similar between HFH and no HFH. After stepwise competing-risk regression, age, left ventricular hypertrophy, E/A ratio > 2, prior prosthetic valve, pulmonary artery pressure (PASP) > 40 mmHg, and splenomegaly were associated with increased risk of HFH while ruxolitinib use was associated with decreased risk. Patients who had HFH had higher risk of death (adjusted HR 1.64, 95% CI 1.16–2.32) and MPN disease progression (adjusted SHR 1.99, 95% CI 1.05–3.77). Among patients with MPN who underwent TTE, HFH is common and associated with worse outcomes. We identified CV and hematologic risk factors for HFH. Further studies are needed to improve HF outcomes in patients with MPN.