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Predictive value of left ventricular ejection fraction in stem cell transplantation
M Zangari1, M J Henzlova, S Ahmad
1Department of Medicine and Cardiovascular Institute, The Mount Sinai School of Medicine, New York, NY, USA.
Bone Marrow Transplantation
|May 25, 1999
Summary
Assessing cardiac function before stem cell transplantation is crucial. While resting ejection fraction (REF) has limited predictive value, measuring cardiac reserve (deltaEF) through exercise offers vital prognostic insights for transplant outcomes.
Area of Science:
- Cardiology
- Hematology
- Transplantation Medicine
Background:
- Stem cell transplantation (SCT) carries significant peritransplant mortality risks.
- Pre-transplant risk stratification is essential for patient selection and management.
- Left ventricular ejection fraction (LVEF) is a common measure of cardiac function.
Purpose of the Study:
- To evaluate the predictive value of resting ejection fraction (REF) and exercise-induced changes (deltaEF) on mortality following autologous and allogeneic SCT.
- To identify subgroups of patients where REF and deltaEF provide significant prognostic information.
Main Methods:
- A retrospective study of 163 patients undergoing SCT over 7 years.
- Assessment of resting ejection fraction (REF) and exercise-induced increment (deltaEF).
- Follow-up for at least 3 months post-transplant to determine peritransplant mortality.
Main Results:
- REF was only discriminatory for peritransplant mortality in younger (<43 years) patients, especially those undergoing autologous SCT.
- Cardiac reserve (deltaEF) was significantly lower in patients with early death, most notably in younger autologous SCT recipients.
- A combination of decreased REF and low deltaEF was associated with high peritransplant mortality (56%).
Conclusions:
- Resting ejection fraction has limited value for pre-transplant risk assessment.
- Measurement of cardiac reserve during exercise provides crucial prognostic information for SCT candidates.
- Integrating REF and deltaEF assessments can refine risk stratification for SCT patients.