Cardiovascular Adverse Effects of Bruton's Tyrosine Kinase (BTK) Inhibitors

A 66-year-old woman with Waldenstrom macroglobulinemia presents with progressive splenomegaly and fatigue.

Background history includes:

  • Hypertension
  • Heart failure with preserved ejection fraction 
  • Stage III chronic kidney disease

Current medications include:

  • Amlodipine 10 mg once daily
  • Losartan 50 mg once daily
  • Furosemide 40 mg twice daily

Physical examination is notable for:

  • Vital signs: blood pressure 132/80 mm Hg, heart rate (HR) 70 bpm, oxygen saturation 98%
  • Body mass index: 35 kg/m2
  • No jugular vein distention, regular rhythm, no murmurs, 1+ peripheral edema

Electrocardiogram: Sinus rhythm with HR 70 bpm, left ventricular hypertrophy with repolarization abnormalities

Labs reveal the following:

  • White blood cell count 5.6 g/dL, hemoglobin 10.1 g/dL, hematocrit 29.7%, platelets 348,000/mcL, estimated glomerular filtration rate 48 mL/min/m2, immunoglobulin M 3574 mg/dL, lactate dehydrogenase 116 U/L, haptoglobin 250 mg/dL

The oncologist would like to enroll the patient in a randomized controlled trial with novel Bruton's tyrosine kinase (BTK) inhibitor zanubrutinib. The patient is sent to cardiology for cardiovascular (CV) optimization and risk stratification.

Which one of the following statements is correct?

Show Answer