Summary:
A prospective study was conducted in 71 evaluable patients who received myeloablative hematopoietic stem cell transplantation (HSCT) at our facility from 1995 to 2002, to find a sensitive marker for post-transplant heart failure, including echocardiographic systolic and diastolic markers and QTc interval. QTc was found to be an independent and significant risk factor for acute heart failure (AHF) on multivariate logistic regression analysis (OR 1.5, P=0.01, 95% confidence interval (CI) 1.1–2.0), while no significant differences between patients with AHF and those without AHF were found in age, sex, treatment history, type of conditioning regimen, and echocardiographic systolic and diastolic markers. On further analysis, post-transplant risk of AHF appeared to be increased as QTc was prolonged. The post-transplant risk of AHF in the group with longest QTc on multivariate logistic regression analysis was found to be 9.8 times that in the group with shortest QTc (P=0.04, 95% CI 1.0–100). These results suggest that echocardiographic markers are less valuable predictors of post-transplant AHF, but that prolongation of the QTc, an ECG marker, before HSCT is strongly associated with onset of AHF after HSCT.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Lee CK, Harman GS, Hohl RJ, Gingrich RD . Fetal cyclophos-phamide cardiomyopathy: its clinical course and treatment. Bone Marrow Transplant 1996; 18: 573–577.
Santos GW, Sensenbrenner LL, Burke PJ et al. Use of cyclophosphamide for clinical marrow transplantation. Trans Proc 1972; 4: 559–564.
Goldberg MA, Antin JH, Guinan EC, Rappeport JM . Cyclophosphamide cardiotoxicity: an analysis of dosing as a risk factor. Blood 1986; 68: 1114–1118.
Cazin B, Gorin NC, Laporte JP et al. Cardiac complications after bone marrow transplantation. A report on a series of 63 consecutive transplantations. Cancer 1986; 57: 2061–2069.
Gottdiener JS, Appelbaum FR, Ferrans VJ et al. Cardiotoxicity associated with high-dose cyclophosphamide. Arch Intern Med 1981; 141: 758–763.
Quezado ZMN, Wilson WH, Cunnion RE et al. High-dose ifosfamide is associated with severe, reversible cardiac dysfunction. Ann Intern Med 1993; 118: 31–36.
Tarella C, Zallio F, Caraccioio D et al. High-dose mitoxantrone plus melphalan (MITO/L-PAM) as conditioning regimen supported by peripheral blood progenitor cell (PBPC) autograft in 113 lymphoma patients: high tolerability with reversible cardiotoxicity. Leukemia 2001; 15: 256–263.
Hermans C, Straetmans N, Michaux JL, Ferrant A . Pericarditis induced by high-dose cytosine arabinoside chemotherapy. Ann Hematol 1997; 75: 55–57.
Ritchie DS, Seymour JF, Roberts AW et al. Acute left ventricular failure following melphalan and fludarabine conditioning. Bone Marrow Transplant 2001; 28: 101–103.
Olivieri A, Corvatta L, Montanari M et al. Paroxysmal atrial fibrillation after high-dose melphalan in five patients autotransplanted with blood progenitor cells. Blood 1998; 21: 1049–1053.
Yellowlees P, Greenfield C, Mcintyre N . Dimethylsulfoxide-induced toxicity. Lancet 1980; 2: 1004–1006.
Bearman SI, Petersen FB, Schor RA et al. Radionuclide ejection fractions in the evaluation of patients being considered for bone marrow transplantation: risk for cardiac toxicity. Bone Marrow Transplant 1990; 5: 173–177.
Hertenstein B, Stefanic M, Schmeiser T et al. Cardiac toxicity of bone marrow transplantation: predictive value of cardio-logic evaluation before transplantation. J Clin Oncol 1994; 12: 998–1004.
Brockstein BE, Smiley J, Al-Sadir J, Williams SF . Cardiac and pulmonary toxicity in patients undergoing high-dose chemotherapy for lymphoma and breast cancer: prognostic factors. Bone Marrow Transplant 2000; 25: 885–894.
Lehmann S, Isberg B, Ljungman P, Paul C . Cardiac systolic function before and after hematopoietic stem cell transplantation. Bone Marrow Transplant 2000; 26: 187–192.
Suzuki J, Yanagisawa A, Shigeyama T et al. Early detection of anthracycline-induced cardiotoxicity by radionuclide angiocardiography. Angiology 1999; 50: 37–45.
Sung RYT, Huang GY, Shing MK et al. Echocardiographic evaluation of cardiac function in paediatric oncology patients treated with or without anthracycline. Int J Cardiol 1997; 60: 239–248.
Schwartz PJ, Wolf S . QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation 1978; 57: 1074–1077.
Siscovick DS, Raghunathan TE, Rautaharju P et al. Clinically silent electrocardiographic abnormalities and risk of primary cardiac arrest among hypertensive patients. Circulation 1996; 94: 1329–1333.
Herait P, Poutignat M, Marty M, Bugat R . Early assessment of a new anticancer drug analogue: are the historical comparisons obsolete? The French experience with pirarubicin. Eur J Cancer 1992; 28A: 1670–1676.
Casazza AM, Bertazzori C, Pratesi G et al. activity and cardiac toxicity of 4-demothoxy (4-DMD) in mice. Proceedings of the American association for Cancer research, 1970; 20: 16–16.
Lepeschkin E, Surawicz B . The measurement of the QT interval of the electrocardiogram. Circulation 1952; 6: 378–388.
Bazett HC . An analysis of the time-relations of electrocardiograms. Heart 1920; 7: 353–370.
Oh JK, Appleton CP, Hatle LK et al. The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 1997; 10: 246–270.
Schiller NB, Shah PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358–367.
Himelman RB, Cassidy MM, Landzberg JS, Schiller NB . Reproducibility of quantitative two-dimensional echocardiography. Am Heart J 1988; 115: 425–431.
McKee PA, Castelli WP, McNamara PM, Kannel WB . The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971; 285: 1441–1446.
Lopez-Jimenez J, Cervero C, Munoz A et al. Cardiovascular toxicities related to the infusion of cryopreserved grafts: results of a controlled study. Bone Marrow Transplant 1994; 13: 789–793.
van-Besien K, Tabocoff J, Rodriguez M et-al. High-dose chemotherapy with BEAC regimen and autologous bone marrow transplantation for intermediate grade and immunoblastic lymphoma: durable complete remissions, but a high rate of regimen-related toxicity. Bone Marrow Transplant 1995; 15: 549–555.
Appelbaum FR, Deisseroth AB, Graw RG et al. Prolonged complete remission following high dose chemotherapy of Burkitt's lymphoma in relapse. Cancer 1978; 41: 1059–1063.
Appelbaum F, Strauchen JA, Graw Jr RG et al. Acute lethal carditis caused by high-dose combination chemotherapy. A unique clinical and pathological entity. Lancet 1976; 10: 58–62.
Nakamae H, Tsumura K, Hino M, Hayashi T, Tatsumi N . QT dispersion as a predictor of acute heart failure after high dose cyclophosphamide. Lancet 2000; 355: 805–806.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Akahori, M., Nakamae, H., Hino, M. et al. Electrocardiogram is very useful for predicting acute heart failure following myeloablative chemotherapy with hematopoietic stem cell transplantation rescue. Bone Marrow Transplant 31, 585–590 (2003). https://doi.org/10.1038/sj.bmt.1703890
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1703890
Keywords
This article is cited by
-
Cardiovascular risk assessment and management of patients undergoing hematopoietic cell transplantation
Bone Marrow Transplantation (2021)
-
Incidence and predictors of severe cardiotoxicity in patients with severe aplastic anaemia after haploidentical haematopoietic stem cell transplantation
Bone Marrow Transplantation (2019)
-
Acquired long QT syndrome during conditioning for allogeneic stem cell transplantation—are we aware of this side effect?
Annals of Hematology (2018)
-
Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies
Medical Oncology (2018)
-
How we approach patient evaluation for hematopoietic stem cell transplantation
Bone Marrow Transplantation (2010)