{
  "abstract": "Introduction Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the treatment of haematological malignancies. Its associated cytokine release syndrome (CRS) however may place significant stress on the cardiovascular system leading to potential cardiotoxicity from treatment. While a recognised complication from treatment, clinical trials data may be non-representative due to exclusion of significant cardiovascular disease from the trial population. Equally, real world data of cardiotoxicity in CAR-T patients are relatively scarce. Evidence describing the incidence and phenotype of CAR-T–associated cardiotoxicity remains limited with published UK data currently lacking. Real-world information regarding the rates, risk factors, and severity of cardiotoxic phenotypic presentations will be pivotal to developing risk scores and models for CAR-T associated cardiotoxicity. This study describes the incidence and nature of cardiovascular complications in a UK tertiary-centre CAR-T cohort.Method We conducted a retrospective observational study of adult patients undergoing CAR-T therapy at Barts Health NHS Trust between 16/01/2024and 08/02/2026 or haematological malignancies. Institutional cardio-oncology pathways mandated baseline cardiovascular assessment, including electrocardiography and cardiac biomarkers (high-sensitivity troponin and natriuretic peptides where available). Descriptive statistics were used to characterise cardiovascular events and short-term outcomes.Results Twenty-eight patients were included (median age 64 years; 57% male) between 2024 -2026. Indications included Diffuse Large B-Cell Lymphoma (DLBCL), Mantle Cell Lymphoma, and B-Acute Lymphoblastic Leukaemia (B-ALL). Baseline cardiovascular comorbidity was common, with hypertension present in 28.6%, diabetes mellitus in 14.3% and established coronary artery disease in 10.7%. Baseline cardiovascular screening was completed in over 85% of patients, including ECG and cardiac biomarker assessment.Six patients (21.4%) required specialist cardio-oncology review following CAR-T therapy. Presentations were heterogeneous: decompensated heart failure accounted for 50% of referrals, while clinically significant arrhythmias occurred in 33%, including sustained ventricular tachycardia and new-onset atrial fibrillation. One notable case involved a rapid decline in Left Ventricular Ejection Fraction (LVEF) from preserved to 35%, which recovered to 54% following prompt neuro-hormonal blockade and IL-6 blockade - tocilizumab made more difference. Another patient developed acute pulmonary oedema with dynamic ECG changes post-infusion; coronary angiography revealed severe left anterior descending artery stenosis unmasked by haemodynamic stress, requiring successful percutaneous coronary intervention. Despite these events, overall survival at data cut-off was 100%.Conclusions This single-centre experience demonstrates that cardiovascular complications with CAR-T therapy are frequent (21%) and diverse, ranging from reversible cardiac dysfunction to ischaemia. The successful management of these high-risk phenotypes auggests that pre-existing cardiovascular disease should not absolutely preclude CAR-T therapy especially when there is close cardiology/cardio-oncology support. Future work could focus on development of a CAR-T Cardiotoxicity Score, integrating advanced cardiac imaging and biomarkers, to enhance the precision of risk prediction and guide pre-emptive management strategies",
  "authors": [
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Mahmoud J Kaswal"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "James Wilson"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Ayshia Bibi"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Abhinav Kandala"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Charlotte Manisty"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Mark Westwood"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Tom Crake"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Edward Truelove"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Rebecca Auer"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Aruni Ghose"
    },
    {
      "affiliations": [
        "Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK, London, United Kingdom"
      ],
      "name": "Arjun K Ghosh"
    }
  ],
  "title": "396 Cardiovascular toxicity associated with car-t cell therapy: a real-world uk tertiary-centre experience",
  "uid": "32f603cf-eef2-5704-bdab-6b8f57bbec52"
}