Cardiovascular function in children following bone marrow transplant: A cross-sectional study
Cardiovascular function in children following bone marrow transplant: A cross-sectional study
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DOI：
10.1038/sj.bmt.1700600
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发表时间：
1997-01-01
影响因子：
4.8
通讯作者：
Neglia, JP
中科院分区：
文献类型：
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作者：
Eames, GM;Crosson, J;Neglia, JP
对63例年龄小于或等于18岁的BMT患者进行横断面评估，以确定心脏功能以及心脏异常的长期患病率、类型、严重程度和危险因素。患者在bmt后大于或等于1年，通过病史、静息心电图、超声心动图（ECHO）、运动跑步机试验、胸部x线、肺功能检查和既往心脏研究回顾进行评估。患者根据活动和心脏症状问卷被分配到纽约心脏协会（NYHA）的等级。移植前准备方案包括高剂量环磷酰胺（CY）和全身/淋巴细胞照射（n = 38）， CY联合其他化疗（n = 22）和其他药物联合（n = 3）， 40例（63.5%）患者既往接受过蒽环类药物（中位307 mg/m(2)），患者年龄1.9 ~ 32岁（中位10.9岁），中位随访3.3年（1 ~ 16.3年）。26例（41.3%）患者在随访中发现心脏异常，其中21例患者在bmt前评估中未发现异常。静息心电图异常10例（16.4%）。3例患者左室射血分数（LVEF）轻度下降至50-54%，1例患者明显下降至40%，仅有1例患者（1.7%）出现27%的轻度异常缩短分数，所有ECHO异常患者均无症状。31名大于或等于9岁的患者中有23名（74%）接受了跑步机运动试验，对运动有边缘性或异常反应。人口学因素、既往治疗、准备方案或随访时间与bmt后心电图、ECHO和跑步机异常无相关性，总体而言，8例（12.7%）患者有症状，NYHA II级或III级，所有患者都有异常的运动试验，症状和NYHA级别的存在是运动时耗氧量的预测因子（P分别= 0.03和0.02），也倾向于预测跑步机的总体结果。儿童期BMT后确实会发生晚期心脏异常，因此，移植幸存者显然需要持续、连续、长期的心脏评估，评估应包括运动应激测试，以检测心输出量不足以及运动时的耗氧量。
Sixty-three patients who had undergone a BMT at age less than or equal to 18 years were evaluated cross-sectionally to determine cardiac function as well as the long-term prevalence, types, severity, and risk factors of cardiac abnormalities. Patients were greater than or equal to 1 year post-BMT and were evaluated by history, resting ECG, echocardiography (ECHO), exercise treadmill test, chest X-ray, pulmonary function tests and review of past cardiac studies. Patients were assigned a New York Heart Association (NYHA) class based on an activity and cardiac symptoms questionnaire. Pretransplant preparative regimens included high-dose cyclophosphamide (CY) and total body/lymphoid irradiation (n = 38), CY in combination with other chemotherapy (n = 22), and other drug combinations (n = 3), Forty patients (63.5%) had received prior anthracyclines (median 307 mg/m(2)), Patients' ages ranged from 1.9 to 32 years (median 10.9 years) with median follow-up of 3.3 years (range 1-16.3 years). Twenty-six patients (41.3%) had a cardiac abnormality detected at follow-up, In 21 patients the abnormal finding had not been present at the pre-BMT evaluation. Ten patients (16.4%) had resting ECG abnormalities. Left ventricular ejection fraction (LVEF) by ECHO was mildly decreased to 50-54% in three patients and markedly decreased to 40% in one patient, Only one patient (1.7%) developed a mildly abnormal shortening fraction of 27%, All patients with ECHO abnormalities were asymptomatic. Twenty-three of 31 patients greater than or equal to 9 years of age (74%) who underwent a treadmill exercise test had a borderline or abnormal response to exercise. There was no correlation between demographic factors, previous therapy, preparative regimen or length of follow-up with the post-BMT ECG, ECHO and treadmill abnormalities, Overall, eight patients (12.7%) were symptomatic and NYHA class II or III, and all had abnormal exercise tests, The presence of symptoms and NYHA class were predictors for oxygen consumption during exercise (P = 0.03 and 0.02, respectively) and tended to predict overall treadmill results also. Late cardiac abnormalities do occur following BMT in childhood and thus, there is a clear need for continued, serial long-term cardiac evaluation in transplant survivors, Evaluations should include exercise stress testing to detect inadequate cardiac output as well as oxygen consumption during exercise.