BACKGROUND:Although posttransplant cyclophosphamide (PT-Cy) is currently widely used to prevent graft-vs-host disease after allogeneic hematopoietic stem cell transplantation (alloHSCT), concerns remain regarding its cardiotoxicity. The aim in this study was to assess the association between early cardiotoxicity occurring within the first 100 days posttransplant and PT-Cy. METHODS:We conducted a monocentric retrospective observational study including all consecutive patients who underwent alloHSCT at Saint Louis University Hospital between July 2011 and July 2023. The primary endpoint was a composite of early cardiotoxicity, including cardiovascular death, heart failure (HF), myocarditis, pericardial disease, cardiac arrhythmias, and acute arterial events. Propensity-score matching was performed to balance characteristics between patients who received posttransplant PT-Cy and those who did not. Predictors of early cardiotoxicity were analyzed using Fine and Gray subdistribution hazard models. RESULTS:Among 1381 patients, 143 (10%) experienced early cardiotoxicity within 100 days posttransplant. The most frequent events were HF (53%), cardiac arrhythmias (20%), and pericardial disease (19%). Age (subdistribution hazard ratio [sHR] 1.01, 95% confidence interval [CI] 1.00-1.03, P = 0.028), prior HF (sHR 2.02, 95% CI 1.04-3.93, P = 0.037), prior cancer therapy-related cardiac dysfunction (sHR 4.24, 95% CI 2.05-8.78, P < 0.001), hypertension (sHR 1.54, 95% CI 1.00-2.36, P = 0.047), and PT-Cy (sHR 1.62, 95% CI 1.07-2.44, P = 0.022) were independently associated with early cardiotoxicity. After 1:1 propensity-score matching, the administration of PT-Cy remained associated with cardiotoxicity (HR 2.00, 95% CI 1.05-3.80, P = 0.035). CONCLUSIONS:The administration of PT-Cy was independently associated with an increased risk of early cardiotoxicity, particularly HF. These results underscore the need for early cardiovascular risk assessment and tailored surveillance, particularly in patients receiving PT-Cy.

Background: Recreational drug use is increasingly associated with adverse outcomes in acute coronary syndrome (ACS) patients, but differences in long-term outcomes between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction are not well defined. Objective: The authors evaluated the association between recreational drug use and major adverse cardiovascular events (MACE) 1 year after intensive cardiac care unit (ICCU) admission in ACS patients. Methods: The Addiction in Intensive Cardiac Care Units study systematically screened all patients admitted to ICCUs across 39 French centers (April 7-22, 2021) via prospective urinary testing. The primary outcome was MACE, defined as cardiovascular death, nonfatal myocardial infarction, or stroke. One-year follow-up was collected through clinical visits or direct contact between patients and cardiologists, concluding in June 2022. Outcomes were adjudicated by an independent cardiology committee. The prognostic impact of recreational drug use on MACE was assessed using multivariable Cox proportional hazards models, validated by propensity matching. Results: Of 712 ACS patients, 13.5% had recreational drug detection. At 1 year, MACE occurred in 7.0%, with higher rates among drug-positive vs drug-negative patients (12.5% vs 6.2%). Recreational drug use was associated with increased MACE (HR: 2.70; 95% CI: 1.30-5.57; P = 0.013). This association was significant in STEMI (HR: 4.11; 95% CI: 1.60-10.5; P = 0.005) but not in non-ST-elevation myocardial infarction patients. Propensity matching confirmed this in STEMI patients (HR: 3.39; 95% CI: 1.19-9.62; P = 0.022). Conclusions: Recreational drug use was associated with increased 1-year MACE risk in ACS patients, particularly STEMI, supporting routine drug screening.

BACKGROUND:Stress perfusion cardiovascular magnetic resonance (CMR) integrates assessment of myocardial ischemia, scar, and function. Its incremental prognostic value in patients with left ventricular (LV) systolic dysfunction remains uncertain. METHODS:We analyzed a prospective multicenter registry of consecutive patients undergoing vasodilator stress perfusion CMR at three French centers (2008-2024). Patients with CMR-derived LVEF <50% were included. The primary end point was all-cause mortality. Associations were estimated with multivariable Cox models. Incremental prognostic value of ischemia and late gadolinium enhancement (LGE) beyond clinical factors and LVEF was assessed by likelihood-ratio χ2, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS:Among 5,977 patients (79% men; age 66±12 years, mean LVEF 42±7%), inducible ischemia was present in 19% (mean extent 2.4±1.2 segments). Over a median follow-up of 9 years, 1,343 patients (22%) died. Ischemic segment extent was independently associated with mortality (HR per segment 1.11; 95% CI, 1.06-1.15; p<0.001). Adding ischemia and LGE to clinical factors and LVEF improved model fit and reclassification (global χ2 increased from 707 to 728; NRI 0.217; IDI 0.004; all p<0.001). Findings were consistent across LVEF subgroups (40-50% and <40%). In secondary analyses among patients with ischemia, outcomes differed by subsequent revascularization status; these findings are observational and hypothesis-generating. CONCLUSIONS:In patients with LVEF <50%, ischemic burden on stress-CMR is independently associated with long-term mortality beyond clinical factors, LVEF and LGE. Integrating ischemia and scar metrics provides incremental prognostic information that may aid risk stratification using stress-CMR in LV systolic dysfunction.

AIMS:The aim of this study was to evaluate the prognostic value of stress perfusion cardiovascular magnetic resonance (CMR) in diabetic vs. non-diabetic patients and then in symptomatic vs. asymptomatic diabetics. Diabetic individuals are at increased risk of coronary atherosclerosis. A significant percentage of diabetics fail to perceive the typical symptoms of myocardial ischaemia. Screening methods such as coronary computed tomography angiography (CCTA) or single-photon emission computed tomography (SPECT) have not shown clear benefits in asymptomatic diabetics. The role of stress CMR in this population is not well established. METHODS AND RESULTS:Between 2008 and 2018, all consecutive diabetic and non-diabetic patients without known cardiovascular disease referred for stress perfusion CMR in two tertiary centres were included. Propensity score matching was used to create a cohort of diabetic vs. non-diabetic patients with similar baseline characteristics. All patients were followed for the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular death or non-fatal myocardial infarction. Diabetic patients were categorized into symptomatic and asymptomatic patients. Out of 3485 eligible patients, 1359 diabetics and 1359 non-diabetics (mean age 69 ± 12 years, 57.4% women) with similar propensity scores were included. Over a median follow-up period of 6.5 (5.9-8.9) years, 386 (14.2%) experienced MACEs. Kaplan-Meier analysis for the occurrence of MACE indicated that the extent of ischaemia or late gadolinium enhancement involving ≥3 segments were independent predictors of the occurrence of MACEs {hazard ratio [HR]: 7.14 [95% confidence interval (CI), 5.01-10.02] and HR: 5.03 [95% CI, 3.47-7.29]; both P < 0.001, respectively}, with no significant differences between diabetics and non-diabetics. Asymptomatic diabetics (n = 255) showed similar event rates as symptomatic patients (P = 0.98). CONCLUSION:Stress CMR provides valuable prognostic information in diabetic patients, irrespective of symptoms. Further assessment is needed to determine whether stress CMR should be a standard screening tool for diabetic patients.

BACKGROUND:Identifying patients with chronic coronary syndrome who will benefit most from a coronary revascularization strategy is essential. Data on the performance of stress cardiac magnetic resonance (CMR) to guide revascularization are limited. To assess the long-term prognostic impact of stress CMR-guided revascularization strategy to predict all-cause death. METHODS:We conducted an observational study including all consecutive patients who underwent stress CMR for suspected or known chronic coronary syndrome in 3 centers in France. CMR-guided coronary revascularization was defined as any revascularization performed within 90 days following stress CMR. The primary outcome was all-cause death. RESULTS:A total of 50 701 patients were included (mean age, 64±12 years; 68.5% men). After a median follow-up of 7.2 years (interquartile range, 3.0-11.0), 3665 (7.2%) patients died. Among the 7396 patients with ischemia, 6523 (88%) underwent revascularization. Ischemia and late gadolinium enhancement (LGE) without viability were independent predictors of death (adjusted hazard ratio, 3.67 [99.5% CI, 3.15-4.27] and adjusted hazard ratio, 1.26 [99.5% CI, 1.10-1.44], respectively; P<0.001 for both). CMR-guided revascularization was an independent predictor of improved survival in the overall population (adjusted hazard ratio, 0.30 [99.5% CI, 0.25-0.36]). In a 1:1 propensity-matched cohort of 1700 patients, CMR-guided revascularization remained independently associated with a lower incidence of death (adjusted hazard ratio, 0.37 [99.5% CI, 0.28-0.50]; P<0.001). This beneficial effect was observed in patients without LGE or with LGE and viability (P<0.001 for both), but not in those with LGE without viability (P=0.23). CONCLUSIONS:In this registry of consecutive patients with chronic coronary syndrome from 3 centers, stress CMR-guided revascularization was associated with a lower rate of death. The combined assessment of inducible myocardial ischemia and LGE may help to select patients most suitable for revascularization.

AIMS:Patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT) are at increased risk of cardiovascular complications; however, comprehensive data on these risks in large cohorts remain limited. This study aims to identify predictors of cardiovascular events in a large cohort of alloHSCT patients. METHODS AND RESULTS:We conducted a retrospective monocentric study including all consecutive patients aged 15 years and older with haematologic malignancies who underwent alloHSCT between 2011 and 2020. Data were extracted from electronic medical records, including demographic, clinical, and transplant-specific variables. The primary composite outcome was cardiotoxicity including cardiovascular death, heart failure (HF), rhythm/conduction disorders, acute arterial events, venous thromboembolism (VTE), and myopericarditis. Predictors of cardiotoxicity were analysed using Cox proportional hazards regression and Fine-and-Gray models. Among 1027 patients recruited (age 45 ± 16 years, 62% male), 30% experienced cardiotoxicity after a median (interquartile range, IQR) follow-up of 4 (1-7) years. The median (IQR) time to the first event was 8 months (3-17). In multivariable analysis, independent predictors for early events (≤100 days) were age, hypertension, history of HF, cancer therapy-related cardiac dysfunction (CTRCD), and high-dose administration of cyclophosphamide (≥100 mg/kg). For late events (>100 days), independent predictors were age, hypertension, history of VTE, atrial fibrillation/flutter, history of HF, CTRCD, previous liposomal anthracycline exposure, and high-risk haematopoietic cell transplantation-comorbidity index (HCT-CI) score category. CONCLUSION:Our study identifies independent predictors of early and late cardiotoxicity, including demographic data, cardiovascular risk factors, history of cardiovascular disease, and oncologic history. REGISTRATION:EBMT registry: CNIL 2093819.

AIMS:Benefits of screening coronary artery disease (CAD) using stress perfusion cardiovascular magnetic resonance (CMR) in patients with hypertension without known CAD is not well established. The aim of our study was to assess the long-term prognostic value of vasodilator stress CMR in patients with hypertension without known CAD. METHODS AND RESULTS:Between December 2008 and January 2022, all consecutive patients with hypertension without known CAD referred for stress CMR were followed up to the occurrence of major cardiovascular events (MACE), defined as cardiovascular mortality or non-fatal myocardial infarction (MI). Cox regressions were performed to determine the prognostic value of each parameter. Among 2019 patients (69 ± 12 years; 45% male) with a median follow up of 6.7 (5.9-8.9) years, 327 had MACE (16%). Patients without ischaemia experienced a lower rate of MACE than those with ischaemia (12% vs. 39%, respectively, P < 0.001). Ischaemia and unrecognized MI were both significantly associated with the occurrence of MACE (respectively, HR: 4.1, 99.5% CI: 3.0-5.7 and HR: 3.6, 99.5% CI: 2.6-5.1, both P < 0.001). After adjustment, both the extent of ischaemia and unrecognized MI were independent predictors of MACE (respectively, HR: 1.2, 99.5% CI: 1.2-1.3, and HR: 1.2, 99.5% CI: 1.1-1.3, both P < 0.001). Adding stress CMR parameters improved model discrimination and reclassification, with greatest improvements in stepwise Model (C-statistic improvement: 0.02; net reclassification improvement: 0.50; integrative discrimination index: 0.02; all P < 0.001). CONCLUSION:In patients with hypertension without known CAD, stress CMR is a long-term predictor for the incidence of MACE and offer an incremental prognostic value over traditional predictors.

BACKGROUND:Although recent work has shown that recent recreational drug use is associated with in-hospital outcomes in patients admitted to the intensive cardiac care unit (ICCU), its cardiovascular consequences after hospitalization for an acute cardiovascular event are not well established. We aimed to evaluate the prognostic impact of recreational drug use at 1-year follow-up on major adverse cardiovascular and cerebrovascular events (MACCE) in patients admitted to the ICCU. METHODS:The ADDICT-ICCU study (Addiction in Intensive Cardiac Care Units) is a prospective multicentric study including all consecutive patients admitted to the ICCU over 2 weeks in April 2021 at 39 French centers. Patients were excluded in cases of scheduled hospitalization, hospitalization within 24 hours before ICCU admission, or in-hospital death. Screening for recreational drug use was performed by a systematic urinary testing upon admission. The primary composite outcome was 1-year MACCE defined as cardiovascular death, nonfatal myocardial infarction, or stroke. Outcomes were adjudicated by 2 senior cardiologists after patient contact and review of anonymized records. A multivariable Cox regression analysis adjusted for traditional prognostic factors was performed to assess the independent association between overall recreational drug use and clinical outcomes. RESULTS:Of the 1392 patients assessed (63±15 years, 69.9% men), 157 (11.3%) had an initial positive test (cannabis or opioids, cocaine, amphetamines, or 3,4-methylenedioxymethamphetamine). After 1-year of follow-up, 94 (6.7%) patients experienced MACCE, with a higher incidence observed among drug users compared with nonusers (12.7% versus 6.0%; risk difference, 6.7% [95% CI, 1.5%-12.2%]). Cannabis or opioid use alone was also associated with MACCE (hazard ratio, 1.77 [95% CI, 1.02-3.08] for cannabis, and hazard ratio, 3.60 [95% CI, 1.57-8.23], for opioids). After adjustment for traditional prognostic factors, recreational drug use remained independently associated with MACCE (hazard ratio, 2.91 [95% CI, 1.68-5.05]). CONCLUSIONS:Recreational drug use markedly increases the risk of 1-year adverse cardiovascular outcomes in ICCU patients highlighting the need for targeted, tailored interventions. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT05063097.

BACKGROUND AND AIMS:Despite current antithrombotic treatments, the recurrence of ischaemic events remains high in patients with diabetes mellitus (DM) or aspirin resistance after acute coronary syndrome (ACS). Whether twice-daily aspirin dosing reduces major adverse cardiovascular events (MACE) in this population remains unknown. METHODS:In this prospective multicentre, randomized trial, patients with ACS and DM or high-risk of aspirin resistance (HRAR) defined as: (i) an index event occurring while on aspirin; (ii) body mass index ≥27 kg/m2; or (iii) increased waist circumference were assigned to receive enteric-coated aspirin once daily (100 mg/day) or twice daily (100 mg morning and evening). The primary outcome was MACE, a composite of any death, myocardial infarction, stroke, urgent coronary revascularization, stent thrombosis, or acute arterial thrombotic event assessed using a time-to-first-event analysis. The main secondary outcome was major bleeding (Bleeding Academic Research Consortium type 3-5). RESULTS:In total, 2484 participants were enrolled (77.2% with DM, 55.5% with ST-elevation segment myocardial infarction). The median follow-up duration was 18 (interquartile range: 17.6-18.3) months. The primary outcome occurred in 95 of 1228 participants (7.7%) in the twice-daily aspirin group, and 110 of 1256 (8.8%) in the once-daily group (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.69-1.19; P = .42). Major bleeding rates were similar between the groups (1.9% vs 2.1%; HR 0.88; 95% CI 0.50-1.55). CONCLUSIONS:In patients with ACS and DM or HRAR, twice-daily aspirin did not significantly reduce the risk of MACE compared to once-daily dosing. No significant difference was observed in major bleeding between groups. TRIAL REGISTRATION:NCT02520921/EUDRACT No: 2015-000947-18.

Abstract Background Late gadolinium enhancement (LGE) extent is the basis for risk stratification of hypertrophic cardiomyopathy (HCM) using cardiac magnetic resonance (CMR). LGE extent has been recently added in the guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology (ACC), setting a threshold at ≥15% of left ventricular mass. However, SCD has become an uncommon event in this population, and mortality is now mostly related to other phenotypes, such as stroke and heart failure. While previous studies have showed the prognostic value of LGE to predict all-cause mortality, the prognostic impact of additional LGE features is not well established. Purpose We aimed to assess the prognostic value of the LGE granularity including extent, location, and pattern in HCM to predict all-cause death. Methods Between 2008 and 2021, all patients referred for HCM assessment using CMR, without history of coronary artery disease (CAD) or clinical history of myocarditis were prospectively recruited in two French centers. The outcome was all-cause death using the French National Registry of Death. The concept of LGE granularity was defined as a model combining LGE extent (by segment), location (septal or others), and pattern (midwall and/or subepicardial). Using nested Cox proportional hazard models, the additional predictive value of LGE granularity was assessed by the C-statistic increment, the continuous net reclassification improvement (NRI), the integrative discrimination index (IDI) and the global Chi-2. Results Among 2,672 patients (52±7 years, 56% males), 862 (32%) had LGE. After a median (IQR) follow-up of 9 (7–11) years, 447 (17%) patients died. Survival curves show an increased risk for LGE presence (log-rank p<0.001, Figure 1A). After adjustment for traditional prognosticators in the overall population (N=2,672), LGE was associated with all-cause death (adjusted hazard ratio (HR) 3.96, 95% CI: 3.26-4.80, p<0.001). Among the LGE subgroup (n=862), survival curves showed that the LGE granularity was associated with a higher risk of all-cause death (all p<0.001, Figure 1B). A nested Cox model adjusted on traditional prognosticators showed that the LGE extent, location and pattern were all independently associated with all-cause death (all p<0.001, Figure 2). The model of LGE granularity combining all independently significative LGE features showed the best improvement in model discrimination and reclassification above traditional prognosticators (C-statistic improvement: 0.90; NRI=41.9%; IDI=13.2%, Chi-2 global=450, all p<0.001; LR-test p<0.001, Figure 2). Conclusion In a large cohort of HCM patients, the LGE granularity model combining the extent, location, and pattern of LGE had an incremental prognostic value over and above traditional prognosticators to predict all-cause death. Prognostic value of LGE in HCM Incremental value of LGE granularity

Aims Although some scores based on traditional statistical methods are available for risk stratification in patients hospitalized in cardiac intensive care units (CICUs), the interest of machine learning (ML) methods for risk stratification in this field is not well established. We aimed to build an ML model to predict in-hospital major adverse events (MAE) in patients hospitalized in CICU. Methods and results In April 2021, a French national prospective multicentre study involving 39 centres included all consecutive patients admitted to CICU. The primary outcome was in-hospital MAE, including death, resuscitated cardiac arrest, or cardiogenic shock. Using 31 randomly assigned centres as an index cohort (divided into training and testing sets), several ML models were evaluated to predict in-hospital MAE. The eight remaining centres were used as an external validation cohort. Among 1499 consecutive patients included (aged 64 +/- 15 years, 70% male), 67 had in-hospital MAE (4.3%). Out of 28 clinical, biological, ECG, and echocardiographic variables, seven were selected to predict MAE in the training set (n = 844). Boosted cost-sensitive C5.0 technique showed the best performance compared with other ML methods [receiver operating characteristic area under the curve (AUROC) = 0.90, precision-recall AUC = 0.57, F1 score = 0.5]. Our ML score showed a better performance than existing scores (AUROC: ML score = 0.90 vs. Thrombolysis In Myocardial Infarction (TIMI) score: 0.56, Global Registry of Acute Coronary Events (GRACE) score: 0.52, Acute Heart Failure (ACUTE-HF) score: 0.65; all P < 0.05). Machine learning score also showed excellent performance in the external cohort (AUROC = 0.88). Conclusion This new ML score is the first to demonstrate improved performance in predicting in-hospital outcomes over existing scores in patients admitted to the intensive care unit based on seven simple and rapid clinical and echocardiographic variables. Trial Registration ClinicalTrials.gov Identifier: NCT05063097.

Background: Although recreational drug use is a strong risk factor for acute cardiovascular events, systematic testing is currently not performed in patients admitted to intensive cardiac care units, with a risk of underdetection. To address this issue, machine learning methods could assist in the detection of recreational drug use.Aims: To investigate the accuracy of a machine learning model using clinical, biological and echocardiographic data for detecting recreational drug use in patients admitted to intensive cardiac care units.Methods: From 07 to 22 April 2021, systematic screening for all traditional recreational drugs (cannabis, opioids, cocaine, amphetamines, 3,4-methylenedioxymethamphetamine) was performed by urinary testing in all consecutive patients admitted to intensive cardiac care units in 39 French centres. The primary outcome was recreational drug detection by urinary testing. The framework involved automated variable selection by eXtreme Gradient Boosting (XGBoost) and model building with multiple algorithms, using 31 centres as the derivation cohort and eight other centres as the validation cohort.Results: Among the 1499 patients undergoing urinary testing for drugs (mean age 63 ± 15 years; 70% male), 161 (11%) tested positive (cannabis: 9.1%; opioids: 2.1%; cocaine: 1.7%; amphetamines: 0.7%; 3,4-methylenedioxymethamphetamine: 0.6%). Of these, only 57% had reported drug use. Using nine variables, the best machine learning model (random forest) showed good performance in the derivation cohort (area under the receiver operating characteristic curve = 0.82) and in the validation cohort (area under the receiver operating characteristic curve = 0.76).Conclusions: In a large intensive cardiac care unit cohort, a comprehensive machine learning model exhibited good performance in detecting recreational drug use, and provided valuable insights into the relationships between clinical variables and drug use through explainable machine learning techniques.

AIMS:To assess the prognostic value of expiratory carbon monoxide (CO) levels in patients admitted for myocardial infarction (MI). METHODS AND RESULTS:In this prospective study, expiratory CO levels were measured upon admission in consecutive patients hospitalized for MI across 39 centres. The primary outcome was 1-year all-cause death. Secondary outcomes included 1-year major adverse cardiac events (MACEs: cardiovascular death and recurrent MI) and in-hospital major adverse events (MAEs: death, severe ventricular arrhythmia, cardiogenic shock, and the need for mechanical ventilation). The prognostic value of expiratory CO levels was further evaluated using machine learning (ML) analysis. Among 717 patients (64 ± 13 years; 75% males; 33% active smokers; 43% ST-elevation MI), elevated expiratory CO levels (>11 ppm) were found in 79 patients (11%). Patients with elevated CO levels had a higher rate of 1-year all-cause mortality compared with those without (16.5% vs. 5.2%, P < 0.001). Elevated CO levels were independently associated with 1-year all-cause death across various adjustment models: comorbidities [odds ratio (95% confidence interval): 3.6 (1.7-7.5)], clinical parameters of in-hospital severity [4.5 (2.3-8.8)], and respiratory parameters [6.3 (3.1-12.8)]. Elevated CO levels were also independently associated with a significant increase in 1-year MACEs and in-hospital MAEs. Machine learning analysis identified CO level as one of the most important predictors of adverse events, compared with other known prognosticators. CONCLUSION:This is the first study to demonstrate that elevated expiratory CO levels upon admission are independently associated with an increased risk of 1-year all-cause mortality, 1-year MACEs, and in-hospital MAEs in patients hospitalized for MI.

Cardiovascular (CV) complications present a significant risk for patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT). However, comprehensive data on these risks within large cohorts remain limited. To identify predictors of CV events in a large cohort of AHSCT patients. We conducted a retrospective monocentric longitudinal cohort study including all consecutive patients with hematologic malignancies who underwent AHSCT between July 2011 and December 2020. Data were extracted from electronic medical records, including demographic, clinical, and transplant-specific variables. The primary outcome was defined as a composite of CV events, including CV death, heart failure (HF), rhythm/conduction disorders, acute arterial events, venous thromboembolism (VTE), and myopericarditis. Predictors of CV events were analyzed using Cox proportional hazards regression and Fine-and-Gray subdistribution hazard models. Among 1,027 patients recruited (age 45±16 years, 62% male), 30% experienced CV events after a median (interquartile range) follow-up of 4 (1-7) years. The median time to the first event was 8 months, with a median age at the first event of 53 (41-61) years. Key predictors for early MACE (≤100 days) included age, hypertension, history of HF, cardiotoxicity related to oncologic therapies, and high-dose of cyclophosphamide. For late MACE (>100 days), predictors included age, hypertension, history of VTE, supraventricular tachycardia, HF, cardiotoxicity related to oncologic therapies, previous liposomal anthracycline exposure, and high-risk Sorror category. Identifying key predictors of CV events is crucial for developing targeted surveillance and preventive strategies, thereby improving management and outcomes for AHSCT patients.Description of all CV events (N=1027) Cumulative incidence functions

L’insuffisance cardiaque (IC) est devenue un problème de santé publique important. Ses conséquences en termes de morbi-mortalité, de coûts de santé sont considérables et vont croissant. L’IC est fréquente chez les patients atteints de diabète (surtout de type 2) soit par dysfonction ventriculaire gauche à la suite d’un infarctus, soit avec une fraction d’éjection conservée chez les patients plus âgés souvent hypertendus avec des troubles du rythme auriculaire. Il convient de bien connaître cette complication. La prise en charge thérapeutique doit être précoce et ne diffère pas de celle de l’IC chez le non-diabétique.