Key result
Chronic ibrutinib linked to a ~2.2 mL/m² increase in LAVI and deteriorating left atrial deformation.
Why the study?
Ibrutinib is associated with cardiovascular adverse events including AF and hypertension, but longitudinal data on left atrial remodeling during treatment are limited.
Does chronic ibrutinib therapy worsen left atrial size and mechanical function in patients with B-cell malignancies?
Observational (n=40)
Yes
Does chronic ibrutinib therapy worsen left atrial size and mechanical function in patients with B-cell malignancies?
Chronic ibrutinib therapy is associated with progressive subclinical left atrial enlargement and worsening mechanical function, suggesting an intermediate phenotype for incident atrial fibrillation.
Serial LA changes on ibrutinib merit closer cardio-oncology surveillance; leaves open whether remodeling predicts AF or warrants intervention.
Background: Ibrutinib is effective for B-cell malignancies but is associated with cardiovascular adverse events, including atrial fibrillation (AF) and hypertension. Longitudinal data on left atrial (LA) remodeling during treatment are limited. We characterized serial changes in LA size and function during chronic ibrutinib therapy. Methods: In this prospective observational cohort, 40 patients starting ibrutinib underwent clinical assessment, 24-72-hour Holter monitoring, and echocardiography with LA strain at baseline and 3, 6, 12, and long-term (nominal 36-month) follow-up. Primary analyses used observed paired data, random-intercept mixed models, standardized response means (SRMs), and Benjamini-Hochberg adjustment across 24 primary contrasts. Results: = 31; all q ≤ 0.020). LA reservoir strain worsened from 6 months onward (all q ≤ 0.031), while LA contractile strain, LA lateral-wall TDI, and LV GLS worsened at every follow-up (all q ≤ 0.009). Results were materially unchanged after adjustment for time-varying hypertension and in complete-case sensitivity analyses. Incident AF occurred in 5/40 patients (12.5%; 95% CI 5.5%-26.1%). Conclusion: During chronic ibrutinib therapy, longitudinal imaging showed modest LA enlargement and consistent deterioration in several LA deformation indices. These treatment-associated observations require confirmation in controlled cohorts. Clinical trial registration: ClinicalTrials.gov, identifier NCT03751410.
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Zeljković et al. (2026) conducted an observational in B-cell lymphoproliferative disorders (n=40). Ibrutinib vs. Baseline was evaluated on Change in left atrial volume index (LAVI) at long-term follow-up (MD 2.17, 95% CI 1.02-3.32, p=≤0.020). Chronic ibrutinib therapy was associated with modest left atrial enlargement, with a mean increase in left atrial volume index of 2.17 mL/m² at long-term follow-up, and consistent deterioration in several left atrial deformation indices.
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