7042 Background: While the association between AFib and CLL has been reported, real-world evidence on its clinical and economic impact is limited. This study evaluated impact of AFib on CV outcomes (stroke, bleeding, heart failure) and HCRU in patients (pts) with CLL overall, by age, and by Bruton tyrosine kinase inhibitor (BTKi) therapy. Methods: This retrospective observational study used the US Symphony database to identify adults newly diagnosed with CLL (2014-2024). Pts were followed for 1 year after CLL diagnosis to assess incidence of AFib. Subsequent CV outcomes (stroke, bleeding, heart failure) and HCRU (inpt, outpt, other services) were compared in CLL pts with and without AFib. Multivariate regression analyses assessed associations between AFib and outcomes. Subgroup analyses were conducted in elderly pts aged ≥65 years. Exploratory analyses compared first-line (1L) BTKi use (ibrutinib, acalabrutinib, or zanubrutinib). Results: In 233,362 newly diagnosed CLL pts, 13.1% had AFib within 1 year of CLL diagnosis. A significantly greater proportion of CLL pts with AFib had ≥1 inpt visit within 1 year of CLL diagnosis than those without AFib (54.9% vs 23.2%, P <.0001), as well as a higher likelihood to incur inpt service (OR: 2.28, 95%CI [2.21, 2.35], P <.0001). Significantly higher proportions of CLL pts with AFib had subsequent stroke (14.3% vs 8.9%), bleeding (27.9% vs 19.1%), and heart failure (54.5% vs 18.9%) than those without AFib ( P <.0001). Age ≥65, male, non-white, and AFib were associated with subsequent stroke, bleeding, or heart failure ( P <.01). Results were consistent in pts aged ≥65 years. In pts initiating 1L BTKi, AFib rate within 1 year of treatment for 1L zanubrutinib vs acalabrutinib vs ibrutinib was 11% vs 13% vs 16%, respectively; P <.0001. Compared to 1L ibrutinib and 1L acalabrutinib, a lower proportion of CLL pts with AFib treated with 1L zanubrutinib had subsequent stroke (12.2% vs 9.4% vs 4.8%, respectively), bleeding (27.4% vs 21.5% vs 17.4%), and heart failure (50.9% vs 45.6% vs 39.6%) ( P <.002). CLL pts with AFib treated with 1L zanubrutinib had less inpt services than 1L ibrutinib and 1L acalabrutinib within 1 year of BTKi treatment (46.4% vs 51.5% vs 60.4%; P <.0001). In multivariate regression, 1L acalabrutinib pts had 29% higher odds than 1L zanubrutinib pts (OR: 1.29, 95% CI [1.12, 1.50], P =.0005); 1L ibrutinib pts had 69% higher odds than 1L zanubrutinib pts (OR: 1.69, 95% CI [1.48, 1.93], P <.0001) to incur inpt service within 1 year after initiating BTKi treatment. Conclusions: Findings highlight significant real-world CV and HCRU burden incurred by CLL pts with AFib. Exploratory analyses suggested 1L zanubrutinib may offer potentially favorable outcomes over other BTKi in lessening AFib and related clinical and HCRU complications. Future studies with longer follow-up are warranted to confirm these findings.

Background: Vascular aging contributes to dementia risk, yet clinically interpretable markers for risk stratification remain limited. Estimated pulse wave velocity (ePWV), derived from age and mean arterial pressure, provides an accessible surrogate of arterial stiffness. We evaluated whether baseline ePWV identifies an interpretable threshold for probable dementia and distinct vascular aging phenotypes.Methods: We conducted a post-hoc analysis of SPRINT-MIND including 8,536 participants free of dementia at baseline. Baseline ePWV was calculated using age and mean arterial pressure. The primary outcome was incident probable dementia adjudicated during follow-up. Associations between ePWV and dementia risk were assessed using spline-based and quartile-based Cox proportional hazards models. Model discrimination was evaluated using Harrell’s C-index.Results: During follow-up, 323 participants developed probable dementia. Dementia risk was lowest at lower ePWV values and increased beyond approximately 10.7 m/s, identifying an interpretable risk threshold. Risk was concentrated in the highest ePWV quartile, consistent with a threshold-like pattern rather than a uniform linear gradient. In exploratory analyses, longitudinal clustering identified distinct ePWV trajectory phenotypes over 24 months.Conclusions: Baseline ePWV identified an interpretable dementia risk threshold and distinct vascular aging phenotypes in SPRINT-MIND. These findings support ePWV as a clinically interpretable marker of vascular aging that may aid dementia risk stratification.

e19020 Background: Ibr is associated with increased risk of fatal cardiac failure in clinical trials; however, real-world (RW) ibr cardiovascular safety data are limited. We assessed RW incidence of CRD in Medicare beneficiaries with BCM receiving ibr. Methods: This retrospective study used the deidentified Medicare Fee-for-Service (FFS) database. Pts were included if they initiated ibr between 2017-2021 (National Death Index [NDI] data cutoff), had ≥2 nondrug claims ≥1 day apart for the same qualifying BCM and had ≥12 mo of continuous Medicare enrollment prior to index date of ibr initiation. Pts were followed until earliest of ibr discontinuation, death, end of enrollment/study. Baseline characteristics were summarized using descriptive statistics overall and by BCM group (CLL/SLL, single non-CLL BCM, multiple BCMs). CRD was defined as diagnosis codes for cardiac arrest/sudden cardiac death (CA), atrial fibrillation/flutter (AF), heart failure (HF), myocardial infarction, ventricular fibrillation/flutter, ventricular tachycardia, sudden death, or ischemic stroke listed as cause of death in NDI. Number and proportion of events were summarized. Incidence rate (IR) was estimated as number of events per 1000 person-years (pys) on ibr. Cumulative incidence was estimated at key times, with death from other causes as a competing risk. Age- and sex-adjusted CRD IR was also estimated among general FFS beneficiaries in 2021. Results: Of 13,241 pts, 10,499 had CLL/SLL, 2,622 had non-CLL BCM, 170 had multiple BCMs. Median age at index was 77.2 years (IQR, 72.2-82.8). Most were male (57.7%) and non-Hispanic White (90.7%). Median baseline NCI comorbidity index was 0.29 (IQR, 0-0.74); most common comorbidities were hypertension (73.6%) and hyperlipidemia (69.2%). A total of 568 (4.3%) CRDs were identified with an overall IR of 35.2 per 1000 pys (Table). Most CRDs were CA (n=243), HF (n=190), or AF (n=148). Median ibr treatment duration was 268 days (IQR, 119-659). In pts with CLL/SLL, median follow-up was 298 days (IQR, 120-718) with most CRDs of CA (n=189; 1.8%), HF (n=147; 1.4%), AF (n=112; 1.1%). Among >16 million general Medicare beneficiaries in 2021, adjusted CRD incidence was 2.1% with an IR of 19.1 per 1000 pys. Conclusions: In this large RW cohort of pts aged ≥65 years with BCM treated with ibr, the incidence of 35.2 CRDs per 1000 pys on ibr was higher than that observed in the general Medicare population of similar age and sex distribution. Most events occurred in first 6 mo of treatment, with cumulative incidence increasing over the duration of ibr exposure. During Ibr treatment Overall CLL/SLL Non-CLL BCM CRD events, n (%) 568 (4.3) 438 (4.2) >120 (>4.5) CRD IR per 1000 pys (95% CI) 35.2 (32.4-38.2) 32.3 (29.3-35.5) 50.6 (42-60.4) Time to event in pts with CRD, median (IQR), days 146.5 (60.5-423.5) 153 (65-456) 135 (47-300) Cumulative CRD probability, %Day 180Day 365 2.73.8 2.63.5 3.34.9

Abstract Bispecific antibodies (BsAb) approved for relapsed/refractory B-cell non-Hodgkin lymphomas (R/R NHL) redirect T-cells to malignant cells and have been associated with cardiovascular adverse events (CVAEs). We analyzed the FDA Adverse Event Reporting System (FAERS) data from December 2022 to September 2025 to characterize the safety of mosunetuzumab, glofitamab, and epcoritamab. Among 246,490 adverse event reports, 1,931 involved BsAbs. CVAEs occurred in 336 (17.4%) BsAb-associated reports of which 132 (39.3%) were fatal. The most frequent CVAEs were shock (3.2%), bleeding (3.0%), and hypotension (2.7%). As a class, BsAbs were associated with increased reporting of hypotension (aROR: 2.15, 95% CI = 1.48–3.13) and fatal CVAEs (aROR: 2.04, 95% CI = 1.60–2.60) compared to all other drugs in the FAERS database. Individual drugs showed distinct patterns: epcoritamab showed the strongest hypotension signal (aROR: 2.37, 95% CI = 1.55–3.62) and increased fatal CVAE reporting (aROR: 2.26, 95% CI = 1.72–2.98), while mosunetuzumab was associated with atrial fibrillation/flutter (aROR: 3.04, 95% CI = 1.53–6.03), supraventricular tachycardia (aROR: 2.72, 95% CI = 1.42–5.21), and tachyarrhythmias (aROR: 2.60, 95% CI = 1.44–4.72). CVAEs occurred earlier than non-CVAEs (median, 10 vs. 16 days, P < 0.001). Cytokine release syndrome occurred in 33.4% of BsAb-related adverse events, with hypotension most commonly overlapping (53.8%), while most arrhythmias occurred independently. These findings highlight cardiovascular toxicity signals associated with BsAbs and underscore the need for continued surveillance, risk stratification, and targeted cardiovascular assessment as these expand into broader clinical practice. However, consistent with the limitations of pharmacovigilance analyses, particularly the reliance on spontaneous adverse event reporting, these observations require confirmation in prospective studies.

Background:Cardiovascular disease is a leading noncancer cause of morbidity and mortality among individuals diagnosed with cancer. Although modern cancer therapies have improved survival, many are associated with cardiotoxic effects that increase the risk of cardiovascular complications. Early identification of cardiovascular symptoms and signs may support timely clinical management. However, tracking cardiovascular health during cancer care can be complex for both patients and medical team participants, and important indicators, such as blood pressure changes, heart rate variability, fluid retention, chest pain, or new-onset fatigue, may be missed between clinic visits. Mobile health technologies offer potential tools to facilitate remote monitoring, yet behavioral factors influencing cardiovascular tracking in cardio-oncology remain insufficiently understood. Objective:This study aimed to identify barriers and facilitators influencing cardiovascular symptom tracking among patients with cancer and medical team participants using the capability, opportunity, motivation-behavior (COM-B) framework. Methods:This qualitative descriptive study included adult patients with cancer (n=12) receiving cardiotoxic therapies and members of their health care teams (n=12), including oncologists, nurses, advanced practice providers, and allied health professionals. Participants were recruited from a cardio-oncology clinic. Semistructured interviews explored perceptions of tracking cardiovascular symptoms and signs. Data were analyzed using rapid qualitative analysis and organized according to COM-B domains. The study received ethical approval, and participants provided informed consent. Results:Patients with cancer and medical team participants described cardiovascular symptom tracking as a shared responsibility. Capability-related themes included uncertainty regarding which symptoms to monitor, appropriate thresholds for concern, and variability in communication practices. Opportunity-related themes included time pressures, competing clinical demands, and the influence of patient-medical team participant relationships and social support. Motivation-related themes reflected perceived benefits of tracking, including reassurance for patients and improved clinical insight for medical team participants, alongside concerns about information burden and unclear actionability. Both groups expressed interest in digital tools that provide clear guidance, defined response pathways, and integration within health care workflows. Conclusions:Cardiovascular symptom tracking in cancer care is shaped by interrelated behavioral and contextual factors affecting both patients and medical team participants. Digital systems intended to support tracking should address knowledge clarity, workflow integration, and actionability of reported information. Understanding these determinants may inform the design and implementation of cardiovascular monitoring strategies in cardio-oncology settings.

Background:Pulse pressure (PP) is associated with cognitive decline but does not account for inter-individual differences in body size that may influence vascular load. We evaluated whether the systemic proportional pulse index (SPI), a body size-indexed pulsatile measure, is associated with incident probable dementia in the Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Methods:We conducted a post-hoc analysis of SPRINT-MIND participants with complete baseline blood pressure and anthropometric data. SPI was calculated as PP indexed to the body surface area. The primary outcome was incident probable dementia adjudicated using standardized SPRINT-MIND protocols. Cox proportional hazards models evaluated associations between SPI and dementia after adjustment for demographic and clinical covariates. Incremental prognostic value was assessed using Harrell's C-index and Akaike Information Criterion. Results:Among 6,070 participants (mean age, 63.2±6.0 years; 65.7% male), 110 (1.8%) developed probable dementia during follow-up. Higher SPI was independently associated with increased dementia risk in models adjusting for PP and body surface area (p=0.031). Participants in the highest SPI quartile had greater risk compared with the lowest quartile (hazard ratio, 2.36; 95% confidence interval, 1.27-4.39). Addition of SPI modestly improved model discrimination and fit beyond PP alone. Conclusions:SPI is independently associated with incident probable dementia and provides modest incremental prognostic information beyond standard clinical factors and PP, suggesting that incorporating body size into assessment of pulsatile load may refine vascular risk stratification for cognitive outcomes, pending external validation.

Cardiovascular adverse events (CVAEs) associated with bispecific T-cell engaging antibodies (BsAbs) have not been systematically investigated across approved agents. In this disproportionality analysis of FAERS (December 2014-September 2025), reports listing BsAbs as the primary suspected drug (n = 7647) were compared with all other drugs in the database (N = 7 289 316) and appropriate active comparators. Adjusted reporting odds ratios (aRORs) were estimated using multivariable logistic regression, adjusting for age, sex, cardiovascular comorbidity, disease, and concomitant cardiotoxic medications. Among 7647 BsAb-associated reports (median age: 60 [36-71] years; 44.6% female), 1408 (18.4%) involved a CVAE and 447 (5.8%) were fatal. BsAbs showed increased reporting of DIC (aROR: 4.35 [3.18-5.96]; n = 49), hypotension (1.61 [1.38-1.89]; n = 181), and fatal CVAEs (1.63 [1.47-1.80]; n = 447). MM-directed BsAbs were associated with shock (2.09 [1.65-2.66]) and myocarditis (3.68 [1.49-9.10]). Blinatumomab was associated with DIC (4.41 [3.05-6.37]) and hypotension (1.46 [1.18-1.81]). Teclistamab showed the strongest myocarditis signal (5.95 [2.16-16.43]; n = 4). Mosunetuzumab showed increased reporting of atrial fibrillation (2.25 [1.15-4.38]) and supraventricular tachycardia (2.21 [1.17-4.15]). CVAEs occurred earlier than non-CVAEs (median 7 vs. 15 days; p < 0.001). The majority of hypotension (56.4%) and heart failure (44.2%) reports occurred independently of both CRS and infection. Case fatality proportions for shock (60.1%), DIC (51.0%), and heart failure (48.1%) exceeded those for CRS (24.3%). BsAb-associated cardiovascular signals, particularly DIC, hemodynamic events, and fatal CVAEs, varied by agent and target antigen. These findings support the need for cardiovascular-specific monitoring during therapy.

Cardiovascular toxicity is an increasingly important limitation of effective contemporary cancer therapies. Yet, the extent to which trials focus on preventing cardiotoxic events in patients receiving contemporary therapies is unknown. Leveraging PubMed, CENTRAL, clinicaltrials.gov, and publicly available reviews to identify all randomized controlled trials (RCTs) testing interventions for prevention or management of cardiotoxicity in cancer patients through 2024, we assessed the proportion of cardiotoxicity prevention trials that studied contemporary cancer therapies (biologic, targeted, or immune-based therapies). We included RCTs of interventional therapies/strategies against cardiotoxicity during cancer treatment. Data on trial baseline characteristics, design, funding, and reporting were extracted. Regression models were used to define trial and population factors associated with drug selection, reporting bias, and subsequent translation into guidelines. Overall, there were 126 trials, evaluating 15 prevention strategies, enrolling 16,111 participants (45.6 ± 13.9 years, 81.3

Anthracyclines are widely used anticancer agents but are limited by dose-dependent cardiotoxicity. Ivabradine selectively reduces heart rate without negative inotropy and may offer cardio protection in cancer patients, though its efficacy in anthracycline-induced cardiotoxicity (AIC) remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ivabradine versus placebo in adult patients receiving anthracycline therapy. PubMed, Cochrane Central, Embase, Web of Science, Google Scholar, Scopus and ClinicalTrials.gov, and reference lists were searched through August 2025. Outcomes included left ventricular ejection fraction (LVEF), heart rate, blood pressure, NT-proBNP, and strain-based parameters. Risk of bias was assessed with the Cochrane RoB 2 tool. Three RCTs (n = 210) met inclusion criteria. Ivabradine showed no significant effect on LVEF (MD 0.32

Cardiovascular toxicity has emerged as a major determinant of long-term outcomes in cancer survivors as advances in oncologic therapies continue to improve survival. Conventional cardiac surveillance strategies predominantly rely on functional and structural changes, often identifying myocardial injury after clinically significant damage has occurred. The aim of this narrative review is to critically evaluate the role of nuclear imaging in advancing precision cardio-oncology by enabling earlier, mechanism-based detection and characterization of cancer therapy-related cardiotoxicity. We summarize current clinical applications of PET- and SPECT-based imaging, examine molecular and tracer-level innovations, and discuss emerging hybrid imaging and analytic approaches relevant to individualized cardiovascular risk stratification. Current literature indicates that nuclear imaging provides unique insights into myocardial perfusion, metabolism, inflammation, and microvascular dysfunction, facilitating detection of subclinical injury across diverse anticancer therapies, including anthracyclines, targeted agents, and immune checkpoint inhibitors. By integrating molecular imaging with conventional modalities, nuclear techniques support more personalized surveillance and management strategies. This narrative review highlights nuclear imaging as an emerging complementary modality within precision cardio-oncology supporting earlier detection and risk stratification, and outlines future directions required to optimize its clinical integration and impact on cardiovascular outcomes across the cancer care continuum.