A New Scoring System for the Evaluation of Ibrutinib-Associated Arrhythmias in Chronic Lymphocytic Leukemia: The ACEF...

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Bruton tyrosine kinase (BTK) inhibitors, like ibrutinib, are used for chronic lymphocytic leukemia (CLL).
• BTK inhibition can disrupt cardiac protective pathways (PI3K-AKT), potentially increasing arrhythmia risk.
• Predictive tools for cardiac adverse events in CLL patients on ibrutinib are needed.

Purpose of the Study:

• To evaluate the predictive capability of the Age-Creatinine-Ejection Fraction (ACEF) score for arrhythmia development.
• To assess the incidence of paroxysmal atrial fibrillation (PAF) in CLL patients treated with ibrutinib compared to controls.

Main Methods:

• Retrospective analysis of CLL patients receiving ibrutinib (≥1 year) and a control group.
• Echocardiography and Holter monitoring were performed.
• ACEF score calculated using age, creatinine, and ejection fraction.

Main Results:

• No significant difference in overall arrhythmia types between groups, except for PAF.
• PAF occurred more frequently in ibrutinib users (22%) vs. non-users (8%).
• An ACEF score >1.21 predicted PAF development in ibrutinib users with 77% sensitivity and 75% specificity (AUC=0.830).

Conclusions:

• The ACEF score is a valuable tool for predicting PAF risk in CLL patients initiating ibrutinib therapy.
• Early identification of high-risk patients can guide clinical management and monitoring.
• Further research may explore interventions to mitigate BTK inhibitor-associated cardiac risks.