Cardiac diagnostic modalities in polycythemia vera: A narrative review

Polycythemia vera is a chronic myeloproliferative neoplasm in which erythrocytosis, Janus kinase-signal transducer and activator of transcription activation, inflammation, endothelial dysfunction, and abnormal blood-cell activation converge to increase cardiovascular risk. This narrative review examines how electrocardiography, echocardiography, coronary angiography, cardiac magnetic resonance imaging, and right-heart catheterization contribute to recognition and characterization of cardiac involvement in polycythemia vera. Reported abnormalities include QT and P-wave changes, atrial arrhythmias, acute coronary syndromes, subclinical biventricular dysfunction, pulmonary hypertension, intracardiac thrombosis, and hypertrophic remodeling. Large observational datasets in myeloproliferative neoplasms also exhibit clinically important burdens of myocardial infarction, heart-failure hospitalization, bleeding, and echocardiographic pulmonary hypertension, although polycythemia vera-specific estimates remain limited. Baseline cardiovascular testing is increasingly relevant before novel therapies and trial enrollment; however, an abnormal test should prompt confirmation, reversible-cause assessment, and protocol-specific review rather than be treated as a universal contraindication. Hematocrit control and low-dose aspirin reduce thrombotic events, while evidence that cytoreductive therapy reverses electrocardiography or imaging abnormalities remains sparse. A symptom- and risk-directed diagnostic approach, integrated with hematology and cardiology assessment, is therefore more defensible than routine universal cardiac screening.