563 THE ROLE OF ECHOCARDIOGRAPHY FOR MANAGEMENT OF IBRUTINIB RELATED ATRIAL FIBRILLATION: ONE MORE SUPPORT OVER CLINICAL EVALUATION
Authors: Gammaldi Vittoria , Pucci Martina , Mocerino Luca , Iannotta Raffaella , Giannattasio Maria Luisa , Tartaglia Benedetta , Iadevaia Velia , Fierarossa Carmine , Chiurazzi Federico , Esposito Roberta 
Published: December 2022

Abstract

Background
Ibrutinib is a Bruton tyrosine kinase inhibitor, approved in the last few years for treatment as primary option for all subsets of chronic lymphocytic leukemia (CLL). Its use is associated with increased incidence of atrial fibrillation (AF).

Objectives
Aim of this study is to determine whether there are echocardiographic parameters that could identify patients at major risk of developing ibrutinib-related atrial fibrillation (IRAF).

Methods
We performed a retrospective review of 26 patients (mean age 70,34 ± 11,69; 27% females), admitted at our EchoLab in the last year, who underwent echocardiogram prior to Ibrutinib treatment. Echo-Doppler assessment was realized according to the standards of the European Association of Cardiovascular Imaging (EACVI) standardization of the echo report. Left atrial (LA) strain was measured with EchoPAC, obtaining peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) on 4-chambers and 2-chambers views. Continuous normally distributed variables were compared by using the Student t-test. A probability value &lt; 0,05 was considered statistically significant. Analyses were performed with SPSS version 25 (IBM Corporation, Somers, New York).

Results
Six patients developed IRAF (23%). There weren't differences of clinical characteristics between the two groups (age, body mass index, arterial blood pressure, heart rate and diabetes, hypertension and cardiovascular diseases prevalence). It was noticed that IRAF's group had lower ejection fraction (EF) (54,67 ± 1,96 vs 60,90 ± 4,35, p-value &lt; 0,0001), higher left atrium volume index (48,95 ± 16,31 vs 34,18 ± 9,07, p-value: 0,009), higher pulmonary arterial pressure values (PAPs) (44,16 ± 11,26 vs 32,89 ± 8,44, p-value: 0,015). Furthermore, it was noticed that peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) were reduced in patients who developed IRAF (PALS 4Ch: 18,89 ± 6,90 vs 29,40 ± 9,79, p-value 0,06; PACS 4Ch: 10,56 ± 5,66 vs 14,31 ± 5,72, p-value: 0,25; PALS 2Ch: 23,36 ± 5,02 vs 32,88 ± 16,57, p-value: 0,28; PACS 2Ch: 13,61 ± 8,16 vs 18,33 ± 9,87, p-value: 0,39), but not statistically significant, probably due to the sample size.

Conclusions
This is a preliminary pilot study which confirms the data already present in the literature. The importance of baseline evaluation by echocardiogram including measurement of atrial strain of patients before starting treatment with Ibrutinib is emphasized since, given the same anthropometric characteristics and risk factors, there are echocardiographic parameters that help us to identify patients at major risk of developing IRAF. Pharmacological intervention tailored on this type of basal echocardiographic evaluation could allow the reduction of IRAF's onset and improve patient outcomes in the long term. Certainly, further follow-up studies will be needed to confirm this hypothesis.