Echocardiographic high-output heart failure is associated with worse survival among patients with myelofibrosis

Myelofibrosis (MF) is a type of myeloproliferative neoplasm (MPN) that is associated with significant morbidity and mortality including progression to acute leukemia and cardiovascular disease (CVD). High-output heart failure (HOHF) has been previously associated with MF, though its impact on outcomes is unknown. To investigate the impact of HOHF on outcomes among patients with MF. This was a multicenter retrospective cohort study of MF patients from 2010-2024 with ≥ 1 transthoracic echocardiogram (TTE). Doppler estimation of cardiac index on TTE and pulmonary artery systolic pressure (PASP) was estimated and HOHF was defined as cardiac index of ≥ 3.54 L/min/m2 and PASP > 40 mmHg. Patients with vs without HOHF were compared. Primary outcome was death or leukemia transformation. Multivariable Cox proportional hazards regression was performed to explore association between HOHF and primary outcome. Of 114 patients included, 19 (16.7%) had HOHF, 46 (40.4%) were female. Patients with HOHF were more likely to have secondary MF and lower hemoglobin levels. After Cox proportional hazards regression modeling, HOHF was associated with increased risk of primary outcome (aHR 2.86, 95% confidence interval 1.01 – 8.09). Among patients with MF, HOHF was associated with increased risk of death or leukemia progression. These findings suggest that echocardiographic evaluation of patients with MF for HOHF may aid in the identification of patients at risk of hematologic progression or poor outcomes, in addition to traditional risk factors. Prospective studies are needed to investigate the utility of echocardiographic screening for patients with MF.