Background:
With better health care, hematopoietic stem cell transplantation has become possible for older patients. These patients have higher prevalence of diastolic dysfunction. However, it is not known if diastolic dysfunction has an impact on prognosis of these patients.
Methods:
Retrospective data was obtained for adults (>18 years) that underwent hematopoietic stem cell transplantation over a period of 1991 - 2012 (22 years). Demographic, echocardiogrpahic and mortality data were obtained. Cox proportional hazard model was used to analyze diastolic dysfunction as a predictor of mortality, graft versus host disease (GVHD), systolic heart failure (ejection fraction ≤50%) and sepsis. Diastolic dysfunction was defined according to American Society of Echocardiography guidelines.
Results:
Out of 770 patients (mean age 48.9±13.4, women 47.7%) had 91 (11.8%) patients with pre - transplant diastolic dysfunction. Patients with diastolic dysfunction were more likely to be older, hypertensive, ≥2 comorbidities and suffer from solid organ malignancy (p <0.05). Diastolic dysfunction was associated with GVHD (HR 2.69; 95% CI 1.42 - 5.10, p =0.002), post - transplant systolic heart failure (HR 3.25;95% CI 1.68 - 6.29, p=0.0001), 30 - day rehospitalizations (HR 1.81;95% CI 1.22 - 2.45, p = 0.003) and mortality (HR 2.62;95% CI 2.11 - 3.25, p = 0.0001). However, intensive care unit treatment, length of stay and sepsis were not associated with pre - transplant diastolic dysfunction.
Conclusion:
Pre - transplant diastolic dysfunction in this group of patients was associated with worse prognosis after transplantation. These findings might help guide therapies and early treatment/management of these patients, so that these complications might be prevented.
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Predictive value of QT dispersion for acute heart failure after autologous and allogeneic hematopoietic stem cell transplantation