Clinical Report: Pericardial Complications Linked to BTK Inhibitors

Overview

In this retrospective Mayo Clinic enterprise cohort, 34 of 575 adults initiating a Bruton tyrosine kinase inhibitor (BTKi) developed incident pericardial effusion or cardiac tamponade (5.9%; 1.9 events per 100 person-years). Adjusted analyses did not identify an association between newer-generation therapy and the outcome compared with ibrutinib, and agent-specific estimates had wide confidence intervals.

Background

BTKis are used to treat B-cell malignant neoplasms and are associated with cardiovascular toxic effects, including arrhythmia, hypertension, bleeding, and heart failure. Pericardial complications associated with newer agents remain incompletely characterized. This study compared incident pericardial effusion or cardiac tamponade by BTKi agent and generation using routine-care records. The related 2023 ASCO meeting abstract addressed cardiovascular adverse events associated with second-generation BTKi therapy, but the supplied context does not provide its results.

Data Highlights

Key Findings

• The retrospective cross-sectional study included adults initiating ibrutinib, acalabrutinib, zanubrutinib, or pirtobrutinib from 2012 through 2025; patients with documented pericardial disease or effusion before treatment were excluded.
• Thirty-four patients experienced incident pericardial effusion or cardiac tamponade; the median time to an event was 683.5 days (IQR, 374.5–1,198.0).
• Cardiac tamponade was reported in three patients, all of whom received ibrutinib; pericarditis was reported in seven patients (1.2%; 95% CI, 0.5%–2.5%).
• Patients with an event were older than those without an event (median age, 82 vs 77 years; P=.01) and more frequently had coronary artery disease (67.6% vs 42.5%; P=.007); these comparisons were descriptive and unadjusted.
• The adjusted hazard ratio for newer-generation agents versus ibrutinib was 0.82 (95% CI, 0.38–1.78); the study reported no association with the primary outcome.
• The related 2023 ASCO meeting abstract is titled “Cardiovascular adverse events associated with second generation Bruton tyrosine kinase inhibitor therapy: A systematic review and meta-analysis”; results are not included in the supplied related-article context.

Clinical Implications

The study authors assessed pericardial events using routine-care notes and echocardiographic reports rather than protocolized surveillance, and the supplied results do not establish a difference in risk among agents. The supplied ACC 2025 concise guidance describes baseline cardiovascular risk assessment and BTKi-specific surveillance, including blood pressure checks at each visit, ECG every 3–6 months, and echocardiography or rhythm monitoring when symptomatic.

Conclusion

Incident pericardial effusion or cardiac tamponade occurred in 5.9% of this cohort, with no association identified between newer-generation BTKi therapy and the primary outcome. The agent-specific estimates were imprecise, and the findings are based on a retrospective, single-enterprise cohort.

Related Resources & Content

1. ASCO Publications, 2023 — Cardiovascular adverse events associated with second generation Bruton tyrosine kinase inhibitor therapy: A systematic review and meta-analysis
2. American College of Cardiology, 2026 — Cardio-Oncology Concise Clinical Guidance Key Takeaways
3. JAMA Oncology, 2026 — Pericardial Effusion and Bruton Tyrosine Kinase Inhibitors in B-Cell Malignant Disease
4. ASCO Publications — Cardiovascular adverse events associated with second generation Bruton tyrosine kinase inhibitor therapy: A systematic review and meta-analysis.
5. ASCO Publications — Cardiovascular adverse events associated with second generation Bruton tyrosine kinase inhibitor therapy: A systematic review and meta-analysis.
6. ASCO Publications — Risk assessment of cardiovascular adverse events with BTK inhibitors in hematological malignancies: Insights from FAERS.
7. American College of Cardiology Cardio-Oncology Concise Clinical Guidance Key Takeaways
8. Pericardial Effusion and Bruton Tyrosine Kinase Inhibitors in B-Cell Malignant Disease