title: Cardiac and autonomic nerve function after reduced-intensity stem cell transplantation for hematologic malignancy in patients with pre-transplant cardiac dysfunction.
abstract: Recent reports have shown that cardiomyopathy caused by hemochromatosis in severe aplastic anemia is reversible after reduced-intensity allogeneic stem-cell transplantation (RIST). We comprehensively evaluated cardiac and autonomic nerve function to determine whether cardiac dysfunction due to causes other than hemochromatosis is attenuated after RIST. In five patients with cardiac dysfunction before transplant, we analyzed the changes in cardiac and autonomic nerve function after transplant, using electrocardiography (ECG), echocardiography, radionuclide angiography (RNA), serum markers, and heart rate variability (HRV), before and up to 100 days after transplant. There was no significant improvement in cardiac function in any patient and no significant alteration in ECG, echocardiogram, RNA, or serum markers. However, on time-domain analysis of HRV, the SD of normal-to-normal RR intervals (SDNN) and the coefficient of variation of the RR interval (CVRR) decreased significantly 30 and 60 days after transplant (P = 0.04 and 0.01, respectively). Similarly, on frequency-domain analysis of HRV, low and high frequency power (LF and HF) significantly and temporarily decreased (P = 0.003 and 0.03, respectively). Notably, in one patient who had acute heart failure after transplantation, the values of SDNN, CVRR, r-MSSD, LF, and HF at 30 and 60 days after transplantation were the lowest of all the patients. In conclusion, this study suggests that (a) RIST is well-tolerated in patients with cardiac dysfunction, but we cannot expect improvement in cardiac dysfunction due to causes other than hemochromatosis; and (b) monitoring HRV may be useful in predicting cardiac events after RIST.
authors.affiliation: Department of Clinical Hematology and Clinical Diagnostics, Graduate School of Medicine, Osaka City University, Osaka, Japan. nakane@med.osaka-cu.ac.jp
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nakane
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Nakamae
authors.forename: Takashi
authors.initials: T
authors.lastname: Muro
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamagishi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Mizuki
authors.initials: M
authors.lastname: Aimoto
authors.forename: Erina
authors.initials: E
authors.lastname: Sakamoto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Terada
authors.forename: Mika
authors.initials: M
authors.lastname: Nakamae
authors.forename: Ki-Ryang
authors.initials: KR
authors.lastname: Koh
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamane
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000502:physiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000294:innervation / Q000502:physiology / Q000503:physiopathology; D019337:Hematologic Neoplasms / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D033581:Stem Cell Transplantation
chemical_list: D015415:Biomarkers