title: Pretransplant-corrected QT dispersion as a predictor of pericardial effusion after pediatric hematopoietic stem cell transplantation.
abstract: Pericardial effusion is a potentially fatal complication following hematopoietic stem cell transplantation (HSCT). Therefore, the identification of risk factors could improve the outcome. Prolonged QT dispersion (QTD) and corrected QTD (QTcD) are associated with serious arrhythmias and sudden death in many forms of heart disease. However, no study has evaluated the efficacy of QTD and QTcD to predict pericardial effusion post-HSCT. We studied 89 pediatric HSCT patients to identify preoperative risk factors for pericardial effusion with particular focus on QTD and QTcD. Pericardial effusion occurred in 15 patients (cumulative onset rate: 17.4%) within one year post-HSCT, of which 8 (9.2%) were symptomatic. Patients with pericardial effusion following allogeneic HSCT showed significantly lower overall survival; however, pericardial effusion was not the direct cause of death in any patient. Univariate and multivariate analyses revealed that transplantation-associated thrombotic microangiopathy (TA-TMA) was an independent risk factor for post-HSCT pericardial effusion. In addition, pretransplant QTcD was significantly prolonged in the pericardial effusion group. These results suggest that pediatric patients with abnormally prolonged QTcD before the preparative regimen for HSCT should be regularly followed-up by echocardiography to detect pericardial effusion, particularly when accompanied by complications including TA-TMA.
authors: Division of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan; Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Ryu
authors: R
authors: Yanagisawa
authors: Eizaburo
authors: E
authors: Ishii
authors: Noriko
authors: N
authors: Motoki
authors: Shoko
authors: S
authors: Yamazaki
authors: Daisuke
authors: D
authors: Morita
authors: Kazuo
authors: K
authors: Sakashita
authors: Masaaki
authors: M
authors: Shiohara
authors: Miyuki
authors: M
authors: Tanaka
authors: Yoshihiko
authors: Y
authors: Hidaka
authors: Noriko
authors: N
authors: Kubota
authors: Eiko
authors: E
authors: Hidaka
authors: Yoshifumi
authors: Y
authors: Ogiso
authors: Tomohiko
authors: T
authors: Nakamura
authors: Satoshi
authors: S
authors: Yasukochi
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D002305:Cardiac Tamponade; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000150:complications / Q000473:pathology*; D020519:Pericardiocentesis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D057049:Thrombotic Microangiopathies / Q000150:complications / Q000473:pathology*; D016896:Treatment Outcome
keywords: cardiac tamponade; fenestration; hemolytic uremic syndrome; pericardiocentesis; thrombotic microangiopathy; thrombotic thrombocytopenic purpura