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Clinical impact of pre-transplant diastolic function on outcome after allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 49, pages 1241–1243 (2014)Cite this article

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Although numerous technical advances in allogeneic hematopoietic SCT (allo-HSCT) have resulted in a marked decrease in TRM, cardiovascular dysfunction is still one of the most significant complications in allo-HSCT. In about half of the patients with heart failure, cardiac systolic function is preserved, and their symptoms are caused by diastolic dysfunction. Furthermore, even asymptomatic diastolic dysfunction has been reported to affect survival.1 The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e′) reflects left ventricular end-diastolic pressure2 and is used for diagnosis of diastolic heart failure.3 Although diastolic dysfunction has a crucial role in the development of heart failure, its clinical impact on allo-HSCT is poorly understood. Thus, we retrospectively analyzed diastolic dysfunction using the E/e′ value in 102 evaluable patients who received their first allo-HSCT between November 2010 and July 2012, and investigated whether pretransplant diastolic dysfunction affected clinical outcomes such as cardiac event, OS or non-relapse mortality (NRM) after allo-HSCT.

Patient characteristics are summarized in Table 1. This study analyzed 58 males and 44 females with a median age of 47 years (range: 15–71 years). Patients were classified into an E/e′-high group when the E/e′ value was ⩾9 or an E/e′-low group when the E/e′ was <9; 41 patients were classified into the E/e′-high group and 61 into the E/e′-low group. The median follow-up period was 366 days after HSCT (range: 2–901 days). Compared with the E/e′-low group, the reduced-intensity conditioning (RIC) regimen was more frequent and the patients were older in the E/e′-high group (Table 1). The cumulative incidence of acute GVHD did not differ significantly between the two groups (P=0.815). Serum ferritin was measured in 70 patients before their HSCT (38 in E/e′-low and 32 in E/e′-high group) and there was no significant difference (P=0.396).

Table 1 Patient characteristics
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Acknowledgements

The authors thank Dr Makoto Saito for his professional advice regarding the statistical analyses.

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Authors and Affiliations

  1. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    N Shingai, K Kakihana, G Oshikawa, T Kobayashi, N Doki, H Sakamaki & K Ohashi

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  1. N Shingai
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  2. K Kakihana
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  3. G Oshikawa
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  4. T Kobayashi
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  5. N Doki
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  6. H Sakamaki
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  7. K Ohashi
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Correspondence to K Kakihana.

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Shingai, N., Kakihana, K., Oshikawa, G. et al. Clinical impact of pre-transplant diastolic function on outcome after allogeneic hematopoietic SCT. Bone Marrow Transplant 49, 1241–1243 (2014). https://doi.org/10.1038/bmt.2014.126

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