CAR T-cell cancer therapies: do not forget the heart

The registry data presented by Mahmood et al.9 demonstrate that CAR T-cell recipients experience severe cardiac events (SCEs) at significant rates. In these patients, cardiovascular risk factors and cardiovascular disease [atrial fibrillation and heart failure including a decline in left ventricular ejection fraction (LVEF)] were significantly more frequent. CAR T-cell infusion exerts direct and indirect effects on the cardiovascular system (via cytokines, activated monocytes/macrophages, and/or directly from T cells). SCEs presented as heart failure, cardiogenic shock, and myocardial infarction, together with increased biomarkers. SCEs in turn were associated with overall and non-relapse mortality.