A dual-center retrospective study published in the JACC: CardioOncology assessed the incidence of cardiovascular events (CVE), cardiovascular mortality, and associated risk factors in patients receiving TCE therapy. The analysis included patients with cancer treated with TCEs between 2016 and 2024. Eligible participants comprised those receiving TCE therapy, with evaluation of on-treatment CVE defined as heart failure (HF), arrhythmias, myocardial infarction (MI), or stroke.

Cumulative incidence of CVE and cardiovascular mortality was estimated using Fine-Gray competing-risk models incorporating time-dependent grade ≥2 cytokine-release syndrome (CRS) and/or immune effector cell–associated neurotoxicity syndrome (ICANS). Associations with all-cause mortality were examined using Cox models including CVE as a time-dependent covariate.

Among 567 patients (median age 67 years; 46.0% female), 25.9% had preexisting cardiovascular disease (CVD). The most frequent malignancies were multiple myeloma and acute lymphoblastic leukemia. Over a restricted mean follow-up of 248 days, 65 CVEs occurred (cumulative incidence 10.4%; 95% CI, 8.1–13.1), most commonly new left ventricular dysfunction (2.3%) and new-onset atrial fibrillation (AF) (2.1%). Cardiovascular mortality was infrequent (0.4%). 

Coronary artery disease (CAD) was the only baseline factor independently associated with CVE risk. Development of grade ≥2 CRS and/or ICANS was associated with a time-dependent increase in CVE risk. CVEs were independently associated with higher all-cause mortality.

TCE therapy showed a generally favorable cardiovascular safety profile. However, CVEs during therapy were associated with increased mortality risk.