scholarly journals Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction

2001 ◽  
Vol 27 (3) ◽  
pp. 307-310 ◽  
Author(s):  
K Fujimaki ◽  
A Maruta ◽  
M Yoshida ◽  
R Sakai ◽  
J Tanabe ◽  
...  
Keyword(s):  
Stem Cell ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Predictive Value ◽  
Cardiac Toxicity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation

2021 ◽  
Vol 10 (14) ◽  
pp. 3013
Author(s):  
Juyoun Kim ◽  
Jae-Sik Nam ◽  
Youngdo Kim ◽  
Ji-Hyun Chin ◽  
In-Cheol Choi
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular Dysfunction ◽  
Predictive Value ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Lvef

Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR ≥ moderate and preoperative LVEF ≥ 60%. LVD and non-LVD were defined as LVEF < 50% and ≥50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3–4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9–29.5%) and 33.2% (26.4–39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73–0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = −0.86, p < 0.001) and regurgitant fraction (CC = −0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.

scholarly journals Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: the MADDEC study

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001007 ◽  
Author(s):  
Nina Syyli ◽  
Markus Hautamäki ◽  
Kari Antila ◽  
Shadi Mahdiani ◽  
Markku Eskola ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Predictive Value ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Grace Score

BackgroundReduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting.MethodsA retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015–2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong’s method for paired samples and by index of discrimination improvement (IDI).ResultsIn univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95% CI 1.030 to 1.042; LVEF: HR: 0.965, 95% CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95% CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95% CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95% CI 0.0016 to 0.0327, p=0.031).ConclusionsAdding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS.

Cardiac Toxicity and Non-Relapse Mortality in Patients with Low Left Ventricular Ejection Fraction Undergoing Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3002-3002
Author(s):  
Diem T. Chu ◽  
Rima Saliba ◽  
Suhail Qureshi ◽  
Amin Alousi ◽  
Paolo Anderlini ◽  
...  
Keyword(s):  
Stem Cell ◽  
Left Ventricular Ejection Fraction ◽  
Myocardial Ischemia ◽  
Cardiac Toxicity ◽  
Hematologic Malignancies ◽  
Left Ventricular ◽  
Acute Myocardial Ischemia ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
History Of

Abstract BACKGROUND: Both autologous and allogeneic stem cell transplantation (SCT) are potentially curative treatment options for patients with hematologic malignancies. Due to a high risk of regimen-related toxicity, only patients with satisfactory organ-system function are considered eligible for this treatment. A low left ventricular ejection fraction (LVEF) of ≤ 45% is considered to be a major risk factor for post-transplant cardiac toxicity and non-relapse mortality (NRM). However, many patients with advanced hematologic malignancies and low LVEF can potentially benefit from this therapy. To address this issue, we studied the incidence of cardiac toxicity and NRM in 89 patients with low LVEF undergoing SCT. METHODS: We performed a retrospective analysis on 89 patients with impaired cardiac function, who underwent an autologous (33 patients) or allogeneic (56 patients) SCT between January 2000 and February 2006 at our institution. Pre-transplant evaluation included bidimensional echocardiogram and an electrocardiogram. Cardiac toxicity was defined as congestive heart failure (CHF), atrial/ventricular arrhythmia or acute myocardial ischemia. In the allogeneic group, 22 patients received a myeloablative (16 busulfan-based, 6 TBI-based), while 34 patients received a fludarabine-based reduced-intensity preparative regimen. Twenty-three patients (41%) received allo SCT from an unrelated donor. The majority of patients in the autologous group received BEAM (with rituximab or IL-2) based regimen (24 patients) and 6 patients received high dose melphalan. RESULTS: 57% of the allogeneic transplants were for acute leukemia. 76% of autologous transplant recipients had Hodgkin’s or non-Hodgkin’s lymphoma. Baseline LVEF, within 30 days prior to SCT, ranged from 20 to 45%. After a minimum of 6-month follow up, cardiac toxicity was seen in 6 patients in the auto SCT group and 6 patients in the allo SCT group (13%). In 9 of the 12 patients toxicity occurred within 60 days of SCT. Major causes of cardiac toxicity were CHF in 6 patients (7%) and atrial fibrillation in 5 patients (6%). Two patients had both CHF and AF. There were no documented episodes of acute myocardial ischemia. Median time to develop a cardiac event was 23 days from SCT (range, 9–200 days). Cumulative incidence of NRM at 100 days was 15% (95% CI 9–24). Only 1 death was directly attributable to a cardiac cause. These results are comparable to SCT performed in patients with normal LVEF. On univariate analysis age > 60 years at the time of SCT and history of smoking were significant predictors for development of cardiac toxicity after SCT. Prior history of smoking remained significant on multivariate analysis (HR 5.7, 95% CI 1.2–29, P=0.03). LVEF, type of transplant or the underlying disease did not emerge as significant predictors of post-transplant cardiac toxicity or NRM. Median survival was worse in patients who developed cardiac complications after SCT (median survival 108 days versus 889 days respectively). CONCLUSIONS: Both allogeneic and autologous SCT are feasible in patients with hematologic malignancies and low LVEF. A prospective study with stratification for cardiac risk factors is warranted in patients with low LVEF.

Outcome of allogenic SCT in patients with low left ventricular ejection fraction

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7099-7099
Author(s):  
S. Qureshi ◽  
F. Bukhari ◽  
R. M. Saliba ◽  
C. Hosing ◽  
R. E. Champlin ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Myocardial Ischemia ◽  
Ejection Fraction ◽  
Cardiac Toxicity ◽  
Hematologic Malignancies ◽  
Left Ventricular ◽  
Acute Myocardial Ischemia ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Post Transplant

7099 Background: High-dose therapy and allogeneic stem cell transplantation (allo SCT) is a potentially curative treatment for patients with hematologic malignancies. Due to a high risk of regimen-related toxicity, only patients with excellent organ-system function are considered eligible for this treatment. A low left ventricular ejection fraction (LVEF) of ≤ 45% is considered to be a major risk factor for post-transplant cardiac toxicity and nonrelapse mortality. However, several patients with advanced hematologic malignancies and low LVEF can potentially benefit from this therapy. To address this issue, we studied the incidence of cardiac toxicity and non-relapse mortality (NRM) in 56 patients with low LVEF undergoing allo SCT. Methods: We performed a retrospective analysis on 56 patients with impaired cardiac function, who underwent an allo SCT between January 2000 and February 2006 at our institution. Pre-transplant evaluation included bidimensional echocardiogram and an electrocardiogram. Cardiac toxicity was defined as congestive heart failure (CHF), atrial / ventricular arrhythmia or acute myocardial ischemia. Twenty-two patients received a myeloablative (16 busulfan-based, 6 TBI-based), while 34 patients received a fludarabine-based reduced-intensity preparative regimen. Results: Twenty-three patients (41%) received allo SCT from an unrelated donor. Acute leukemia was the reason for allo SCT in 32 (57%) patients. Baseline LVEF, within 30 days prior to allo SCT, ranged from 20 to 45%. After a minimum of 6-month follow up, cardiac toxicity was seen in 7 (12%) patients. That included CHF in 4 (7%) and atrial fibrillation (AF) in 4 (7%). One patient had both CHF and AF. There were no documented episodes of acute myocardial ischemia. Cumulative incidence of NRM at 100 days was 12%, none of the deaths being attributable to a cardiac cause. These were comparable to allo SCT performed in patients with normal LVEF. Age, degree of left vetricular dysfunction, type of transplant or the underlying disease did not emerge as significant predictors of post-transplant cardiac toxicity or NRM. Conclusions: Allogeneic SCT is feasible in patients with hematologic malignancies and low LVEF. A prospective study with stratification for cardiac risk factors is warranted in patients with low LVEF. No significant financial relationships to disclose.

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