Haematological cancer survivors are at increased risk of cardiovascular disease (CVD) due to cancer-related biological processes and cardiotoxic cancer therapies. Cardiovascular magnetic resonance (CMR) provides detailed organ-level information about cardiovascular health. However, population-level studies examining long-term cardiovascular health in this population are limited. This study integrates clinical and CMR data from the UK Biobank to define the excess risk of specific CVDs and cardiovascular remodelling patterns in survivors of haematological cancer.

Participants with a record of haematological malignancy prior to baseline recruitment were identified using linked hospitalisation and cancer registry data. Each cancer-exposed participant was propensity score matched to two non-cancer controls on an extensive range of sociodemographic, lifestyle, baseline morbidity, and clinical biomarker variables. Missing covariate data were imputed using predictive mean matching. Cox regression was used to calculate hazard ratios for the following CVD outcomes: chronic ischaemic heart disease, non-ischaemic cardiomyopathy, heart failure, myocardial infarction, atrial fibrillation, pericardial disease, and venous thromboembolism. Incident outcomes were prospectively ascertained from linked hospital and death registry records over a median of 13.6 years. In participants with CMR data available, linear regression was used to examine the association of cancer exposure with CMR-derived metrics of cardiovascular structure and function, and myocardial tissue character. These included ventricular and atrial volumes and function, arterial stiffness strain, and myocardial T1.

A total of 2,166 haematological cancer survivors [median age 61, (IQR: 53-65) years; 56% women] and 4,331 controls were included in the analysis. Cancer survivors demonstrated a significantly increased incident risk for all selected CVDs, with the highest risks observed in relation to pericardial disease [HR=6.38, 95% CI: 3.18-12.83]. Participants with haematological cancer had significantly large left ventricular volumes with poorer function (lower ejection fraction, worse global longitudinal strain), and pronounced myocardial fibrosis (higher T1).

Haematological cancer survivors have a significantly elevated risk of a range of incident CVDs. CMR analysis reveals adverse cardiac remodelling, comprising larger and poorer functioning left ventricle with greater myocardial fibrosis in haematological cancer survivors, compared to matched controls. These findings highlight the excess long-term cardiovascular risk of this cohort and the potential role of imaging biomarkers in risk stratification and understanding underlying mechanisms. GA is supported by the Wellcome Trust (218584/Z/19/Z). JC, CM-G, and DG-C are supported by Barts Charity (G-002389, G-002777).