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BACKGROUND Hematopoietic stem cell transplantation (HSCT) increases the likelihood of potentially serious cardiovascular complications. The scientific evidence on prognostic predictors is limited and cardiac monitoring of these patients is not systematized. Our aim was to analyze cardiovascular prognosis and identify echocardiographic factors predicting cardiovascular events in the context of HSCT. METHODS An observational, retrospective study was designed, including 243 patients (mean age 54 ± 16yo, 60%males, 13% hypertension, 5% diabetes) undergoing a HSCT (60% Allogeneic/40% Autologous) with previous echocardiography, from December 2016 to the present. Clinical data, echocardiographic findings, mortality and cardiovascular events (CVE) were collected and analyzed. RESULTS After a median follow-up of 18 [12] months, 22 patients (9%) suffered CVE (54% arrhythmias, 40% heart failure, and 9% ischemic heart disease). Patients with Allogeneic-HSCT (13% vs. 3%; p: 0.007), left ventricular dilatation (40% vs. 8.5%, p = 0.02) or hypertrophy (33% vs. 8%, p: 0.01), dilated left atrium (33% vs. 9%, p:0.03), or pericardial effusion (33% vs. 9%, p: 0.04) in the echocardiographic study performed prior to HSCT suffered significantly more CVE at follow-up. Patients with CVE had significantly higher global longitudinal strain (GLS) (-19 ± 3% vs. -21 ± 3%, p= 0.001). Patients were divided into quartiles based on GLS, those belonging to the fourth quartile (>-19.4%) suffered more frequently CVE (log Rank: 9.6; 18% vs. 6%, p = 0.002) with a significantly lower time to event (27 ± 1.8 vs. 32 ± 0.6 months) (Figure). In multivariate analysis (Cox regression), Allogeneic-HSCT (HR: 5.6; p = 0.02) and the fourth quartile of GLS (HR: 4.3; p = 0.004) were maintained as independent predictors of cardiovascular event. CONCLUSION GLS before HSCT is an independent predictor of cardiovascular events at follow-up. This parameter could allow the identification of high-risk patients who could benefit from intensive protocolized cardiac follow-up. Abstract P939 Figure. Survival analysis (Kaplan Meier)

Allogenic hematopoietic stem cell transplant (Alo-HSTP)has been a therapeutic revolution for patients with hematologic malignancies. Even though this therapy is associated with a high risk of cardiovascular (CV) events during follow-up, a baseline cardiology study is currently not standardised in most centers. Our aim was to analyse transthoracic echocardiogram (TTE) findings in patients candidates to Alo-HSTP. We undertook a retrospective and descriptive analysis that included all patients treated with Alo-HSTP in our center between 2016-2019. Baseline characteristics and TTE findings including global longitudinal strain (GLS) were analysed. We analyzed 144 patients (mean age 50 years, 60% males). Acute myeloblastic leucemia (38%) and non-Hodgkins lymphoma (18%) were the most frequent diseases. Figure. 18 patients (13%) had hypertension, 13% had dyslipidemia and 6% diabetes mellitus. Almost 10% had previous CV history. TTE found left ventricle systolic dysfunction (LVEF< 53%) in 10% of patients, diastolic dysfunction in 12%, valvular heart disease in 4 patients (5,5%) and GLS was abnormal (>-19%) in 35 patients (24%). Up to 47 (33%) patients studied has an abnormal TTE finding. Table. More than one third of patients candidates to Alo-HSTP had an abnormal TTE finding, increasing the risk for CV events during follow-up. A cardiologic study by the Cardio-Onco-Hematology team in these patients before Alo-HSTP could improve their prognosis. Age (years) 50 ± 18 Male (n,%) 86 (60%) Hypertension (n,%) 18 (13%) Diabetes mellitus (n,%) 8 (5,6%) Dyslipidemia (n, %) 18 (13%) Past or current smoking (n, %) 25 (18%) Previous cardiovascular history (n, %) 13 (9,3%) Abnormal TTE (n, %) 47 (33%) LVEDV(ml) 99 ± 29 LVESV (ml) 37 ± 16 LVEF (%) LV dysfunction (n, %) 63 ± 8 15 (10,4%) e/e´ Elevated filling pressures (n, %) 8,2 ± 7,3 4 (3%) Valvular heart disease (≥moderate) (n, %) Mitral Aortic Tricuspid 3 (2%) 4 (3%) 1 (1%) GLS (%) abnormal GLS , >-19% (n, %) -20,4 ± 2,8 35 (24%) LVEDV: Left ventricle end-systolic volume, LVESV: Left ventricle end-systolic volume, LVEF: Left ventricle ejection fraction, GLS: global longitudinal strain Abstract P1430 Figure. Haematologic malignancies

Current guidelines recommend sacubitril/valsartan (S/V) for patients (p.) with heart failure and reduced left ventricular ejection fraction (LVEF) but there is lack of evidence of its efficacy and safety in p. with cancer and heart failure. Our aim was to analyze the potential benefit of S/V in specific cardio-oncology clinics. Methods We performed a retrospective multicenter registry (HF-COH) in six Spanish hospitals with cardio-oncology clinics including all p. treated with S/V. Clinical and echocardiographic data, NYHA functional class, type of neoplasms and anti-tumoral treatment were described. Median follow-up was 7.2 [7.9] months. Results Sixty-one p. were included (median age was 64 [21] years old; 64%women, 43% hypertensive, 54% dyslipidemics and 28% diabetics). Most of p. (97%) had cancer therapy related cardiac dysfunction (CTRD) with a median time from anti-cancer therapy to CTRD of 40 [132] months. Breast (46%) and hematological (38%) cancers were the most frequent neoplasms, 31% of p. had metastatic disease and 71% had been treated with anthracyclines. In 5% S/V was initiated at CTRCD diagnosis while in 95% S/V was started to improve clinical status in p. already treated with ACE inhibitors or ARBs. 87% were on beta-blocker therapy and 74% on mineralocorticoid receptor antagonists.Maximal S/V titration dose was achieved in 8.2% of p. (24/26mg: 43%; 49/51mg: 33%) S/V was discontinued in 4 p. (reasons: 2 hypotension; 1: renal failure; 1: pruritus) Baseline NT-proBNP levels, functional class, and LVEF improved at the end of follow-up in p. who continued with S/V (all p values ≤0.01). No statistical differences were found in creatinine clearance or potassium serum levels. Table Patient parameters before and after S/V Before S/V After S/V P value LVEF (%) 33 [7] 39.5 [15] Conclusions Our experience suggests that S/V is well tolerated and improves functional class and left ventricular function parameters in patients with CTRCD.