Highlights
- •Patients with myeloproliferative neoplasm (MPN) and atrial fibrillation (AF) have high rates of adverse cardiovascular events.
- •CHA2DS2-VASC and HAS-BLED were poor predictors of thrombotic and bleeding outcomes.
- •Myelofibrosis was associated with the increased risk of composite outcome and all-cause mortality.
- •CHA2DS2-VASC may predict heart failure hospitalizations in patients with MPNs and AF.
- •More research is needed to develop more accurate risk scores in MPNs and AF.
Abstract
Background
Patients with myeloproliferative neoplasms (MPNs), essential thrombocythemia (ET),
polycythemia vera (PV), and myelofibrosis (MF), have increased risk of cardiovascular
(CV) disease. Atrial fibrillation (AF) is associated with adverse CV outcomes including
arterial thrombosis, heart failure (HF), and CV death and coexists with MPN. Traditional
risk scores (CHA2DS2-VASC and HAS-BLED) for estimating risks/benefits of anticoagulation
to prevent thrombotic events in AF do not include MPN status. Therefore, we aimed
to investigate CV outcomes in patients with MPN and AF and evaluate the predictive
ability of traditional risk scores.
Methods
We conducted a single-center, retrospective cohort study of patients with MPN and
AF. Primary outcome was composite of CV death and arterial thromboembolism; secondary
outcomes were bleeding requiring emergency department visit or hospitalization, hospitalization
for HF, and all-cause death. Multivariable competing-risk and Cox proportional hazards
regression models were used to estimate risk of outcomes. Receiver operating characteristic
(ROC) curve used to evaluate predictive ability of CHA2DS2-VASC and HAS-BLED of composite
outcome and bleeding, respectively.
Results
A total 142 patients was included (62 ET, 54 PV, 26 MF). Composite outcome, bleeding,
HF hospitalization and all-cause death occurred in 39 %, 30 %, 34 %, and 48 %, of
patients respectively. After multivariable modeling, MF was associated with increased
risk of composite outcome (SHR 2.70, 95 % CI 1.38–5.27) and all-cause mortality (HR
9.77, 95 % CI 4.88–19.54) but not bleeding (SHR 1.19, 95 % CI 0.51–2.80) or HF admissions
(SHR 0.57, 95 % CI 0.19–1.72). CHA2DS2-VASC and HAS-BLED were poor predictors of composite
outcome (C-statistic 0.52, 95 % CI 0.43–0.62) and bleeding (C-statistic 0.49, 95 %
CI 0.40–0.58), respectively.
Conclusion
In patients with MPN and AF, MF is associated with increased risk of CV death and
arterial thrombosis and traditional risk scores do not accurately predict outcomes
in this patient population. Further investigation is needed to refine risk scores
in this patient population.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 12, 2022
Accepted:
October 10,
2022
Received in revised form:
October 4,
2022
Received:
July 30,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
