Bahnasy, Ahmed

Background Cardiovascular biomarkers such as NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) are used for heart failure risk stratification in patients with acquired heart disease, but there are limited data about its role in patients with congenitally corrected transposition of the great arteries. The current study aims to assess the role of serial NT‐proBNP measurements for risk stratification in adults with congenitally corrected transposition of the great arteries. Methods We studied adults with congenitally corrected transposition of the great arteries with ≥2 NT‐proBNP measurements (2003–2024). Temporal change in NT‐proBNP was calculated as relative change from baseline levels. Results Of 152 patients (age 47±13 years, 45% men), baseline NT‐proBNP was 539 (interquartile range, 193–1549) pg/mL, and relative change from baseline levels of NT‐proBNP was 34% (interquartile range, −11 to 67). Of 152 patients, 45 (30%) had cardiovascular events (heart failure hospitalization [n=29], ventricular assist device [n=5], heart transplantation [n=11], and death [n=10]), yielding a 10‐year incidence of 26%. Higher baseline NT‐proBNP and relative change from baseline levels were associated with cardiovascular events. Serial NT‐proBNP measurements had incremental prognostic value compared with baseline measurement. The correlates of higher NT‐proBNP levels were atrial fibrillation, hypertension, right ventricular dilation and dysfunction, and atrioventricular valve regurgitation. Renin–angiotensin–aldosterone system antagonist was associated with lower NT‐proBNP levels and lower risk of cardiovascular events. Conclusions NT‐proBNP testing is inexpensive, widely available, and noninvasive, making it well suited for longitudinal surveillance in adults with congenital heart disease. Most of the correlates for elevated NT‐proBNP levels were modifiable, providing target for therapeutic interventions.

e19538 Background: Patients with multiple myeloma (MM) and type 2 diabetes mellitus (T2DM) experience increased risks of morbidity and mortality. GLP-1 receptor agonists (GLP-1 RA) offer glycemic and cardiovascular benefits, but their impact on cancer-related outcomes is unclear. This study evaluates the association of GLP-1 RA therapy with clinical outcomes, MM-related biomarkers, and survival in MM patients with T2DM. Methods: We conducted a retrospective cohort analysis using the TriNetX network, including data from 104 healthcare organizations (2014–2019). Two cohorts were defined: (1) MM patients with T2DM starting GLP-1 RA therapy within three months of MM diagnosis and continuing therapy for at least one year (n=1,606 before matching), and (2) MM patients with T2DM not receiving GLP-1 RAs (n=40,306 before matching). Patients included were aged 18 years and older. One-to-one propensity score matching (PSM) balanced systemic MM therapy, BMI, and diabetes medications (e.g., insulin, metformin), yielding 1,279 matched pairs. Outcomes included five-year mortality, ICU and non-ICU hospitalizations, and MM-related biomarkers (hemoglobin, creatinine, neutrophils, and calcium). Most recent lab values were compared in the two groups. Statistical analyses included Kaplan-Meier survival estimates, hazard ratios (HR), risk differences, and T-Test statistics. Results: After PSM, baseline characteristics were well balanced. The mean age was ~ 66 years, white race was ~46%, females were ~ 40%, and hypertension was ~85%. Around 20% of MM patients received autologous transplants and ~27% received lenalidomide in the past. GLP-1 RA therapy was associated with less mortality (HR: 0.44, 95% CI: 0.36–0.54, P < 0.01), ICU admissions (HR: 0.59, 95% CI: 0.50–0.71, P < 0.01), and non-ICU hospitalizations (HR: 0.59, 95% CI: 0.53–0.65, P < 0.01). Patients on GLP-1 RAs had higher hemoglobin levels (11.61 ± 2.30 g/dL vs. 10.75 ± 2.47 g/dL, P < 0.01), with no significant differences in serum creatinine (119.068 µmol/L vs 115.648 µmol/L, P = 0.720) or neutrophils (P = 0.226). Patients who received GLP-1 RAs had higher serum calcium levels (9.17 mg/dL vs. 8.96 mg/dL, P < 0.01). GLP-1 RA use also decreased the incidence of septic shock (HR: 0.53, 95% CI: 0.44–0.64, P < 0.001) and pneumonia (HR: 0.59, 95% CI: 0.49–0.70, P < 0.001). Conclusions: GLP-1 RA therapy improves survival, reduces ICU and non-ICU hospitalizations, and lowers complications in MM patients with T2DM. Biomarker trends over five years suggest potential anticancer effects. Further research should explore whether GLP-1 RAs impact other malignancies, broadening their role in cancer therapy.