A Comprehensive Echocardiographic Assessment of Patients With Chronic Myeloid Leukemia on Dasatinib.

PURPOSE: Dasatinib, a tyrosine kinase inhibitor used to treat chronic myeloid leukemia (CML), is known to cause cardiopulmonary toxicities; however, little is known about the echocardiographic changes associated with this therapy. We present a comprehensive echocardiographic assessment of patients with CML on Dasatinib therapy.

METHODS

We performed a retrospective cohort analysis on adult patients with CML receiving Dasatinib between 2017 and 2023. Comprehensive clinical and echocardiographic data with speckle-tracking analyses were included.

RESULTS

Of 199 patients with CML on Dasatinib, 75 (38%) patients had a pre-Dasatinib echocardiogram, and 49 (25%) patients had both pre- and post-Dasatinib echocardiograms. Among 44 patients with analyzable echocardiograms (average age 59 ± 15 years old, 39% female), 7 (16%) patients had baseline heart failure with preserved ejection fraction (HFpEF). After initiation of Dasatinib, there was a significant increase in left ventricular (LV) end-diastolic diameter index (2.4 [2.2, 2.6] vs. 2.6 [2.4, 2.8]cm/m2, p < 0.01), LV end-systolic volume index (16 [13, 26] vs. 21 [14, 26] mL/m2, p = 0.04) and LV mass index (85.3 [75.4, 94.4] vs. 93.1 [80.6, 114.7]g/m2, p < 0.01). There was a significant increase in left atrial (LA) volume index (LAVI, 29.0 ± 10.6 vs. 33.4 ± 13.0 mL/m2, p = 0.01), decrease in lateral e' velocity (11.8 ± 3.3 vs. 10.4 ± 2.8 cm/sec, p < 0.01) and increase in E/e' (9.5 ± 2.8 vs. 10.7 ± 3.5, p = 0.04) post-Dasatinib. Among patients with abnormal LAVI post-Dasatinib, higher LAVI correlated with worsened LA reservoir strain (r = -0.59, p = 0.01). LV ejection fraction and global longitudinal strain were not significantly changed. Patients with baseline HFpEF were significantly more likely to have progression in diastolic dysfunction compared to patients without HFpEF (p = 0.03).

CONCLUSION

Dasatinib was associated with significant changes in LV structure, LA volume, and diastolic parameters in patients with CML. Patients with baseline HFpEF were more likely to progress in diastolic dysfunction on Dasatinib.