Cardiac involvement in bone marrow transplantation: electrocardiographic changes, arrhythmias, heart failure and autopsy findings.
In order to evaluate cardiac involvement in bone marrow transplantation (BMT) we reviewed serial electrocardiograms, chest X-rays and cardiac pathology at autopsy in 45 consecutive adult patients undergoing BMT for hematologic malignancies at our institution. All patients were pretreated with cyclophosphamide (CY, 120 mg/kg) and total body irradiation (TBI, 10-12 Gy). A total of 15 patients developed electrocardiographic ST-segment or T-wave changes and/or arrhythmias post-BMT; four of them also suffered from congestive heart failure. The arrhythmias included frequent ventricular extrasystoles (two patients), paroxysmal atrial fibrillation (one patient), repeated supraventricular tachycardia (one patient) and QT-prolongation with ventricular tachyarrhythmias (one patient). Twelve patients showed an early drop of the total QRS voltage sum exceeding 15% of the pretransplant reading. In a subgroup of five patients the voltage drop was associated with ST-segment or T-wave changes; three of them developed congestive heart failure. At autopsy in 15 patients, the heart weight was on the average 113% of predicted. Myocardial edema, fibrosis and cellular hypertrophy were the most common microscopic findings. Two patients had marantic endocarditis of the aortic valve. Thus, in our experience clinically significant heart involvement affects 5-10% of patients undergoing BMT after pretreatment with CY and TBI. While cardiac complications are generally not a major problem of BMT, they may have serious consequences for individual patients and should therefore be carefully watched for in the treatment of BMT recipients.
Kupari
M
M
First Department of Medicine, Helsinki University Central Hospital, Finland.
Volin
L
L
Suokas
A
A
Timonen
T
T
Hekali
P
P
Ruutu
T
T
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002051:Burkitt Lymphoma / Q000150:complications; D006332:Cardiomegaly / Q000209:etiology; D003131:Combined Modality Therapy / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D011446:Prospective Studies; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D003520:Cyclophosphamide