Baseline cardiovascular characteristics and post-infusion events in patients undergoing CAR-T cell therapy

Introduction CAR-T cell therapy has significantly advanced the treatment of hematologic malignancies. Cardiovascular complications have been reported, particularly in patients with pre-existing risk factors or cardiovascular disease. Baseline cardiovascular profiles and post-infusion events in real-world practice remain limited. Objective To describe baseline cardiovascular characteristics and the incidence of cardiovascular events after CAR-T therapy in a single-centre cohort. Materials and Methods This prospective, descriptive, non-interventional study included consecutive patients treated with CAR-T between 2019 and 2025. Baseline evaluation included epidemiological data, cardiovascular risk factors, history of cardiovascular disease, SCORE2 risk stratification, and assessment in a cardio-oncology consultation. Baseline imaging (echocardiography and cardiac magnetic resonance) was collected. Patients were followed for cytokine release syndrome (CRS) and cardiovascular events. Descriptive statistics were performed using SPSS v27. Results 236 patients were included (mean age 59 ± 11 years, 61% male). Most patients were treated for lymphoma or multiple myeloma, while a small proportion had other hematologic malignancies. 86% had ≥1 cardiovascular risk factor, 25% had prior cardiovascular disease, and 42% were high or very high risk by SCORE2. Baseline cardio-oncology evaluation identified new cardiovascular diagnoses in 36% of patients and prompted therapy adjustments in 30%, optimizing cardiovascular status prior to CAR-T infusion. CRS occurred in 93% of patients, ≥grade 2 in 31%, mainly early, with a median onset of 3 days (range 0–12). Hypotension was the most frequent cardiovascular manifestation. During follow-up, 16% experienced ≥1 clinically relevant cardiovascular event, most commonly acute heart failure (7%) and atrial fibrillation (4%), with a median time to first event of 144 days. Overall mortality was 31%, mainly due to disease progression, with no deaths attributable to cardiovascular causes. Conclusions CAR-T-treated patients showed high prevalence of cardiovascular risk factors and history of cardiovascular disease, with a notable incidence of post-infusion cardiovascular events. These findings highlight the importance of comprehensive baseline assessment and close follow-up within cardio-oncology units.