Cardiac and autonomic nerve function after reduced-intensity stem cell transplantation for hematologic malignancy in patients with pre-transplant cardiac dysfunction
Cardiac and autonomic nerve function after reduced-intensity stem cell transplantation for hematologic malignancy in patients with pre-transplant cardiac dysfunction
复制标题
移植前心功能不全的血液恶性肿瘤患者减强度干细胞移植后的心脏和自主神经功能
作者：
T. Nakane;H. Nakamae;T. Muro;H. Yamagishi;Yoshiki Kobayashi;M. Aimoto;E. Sakamoto;Y. Terada;M. Nakamae;Ki‐Ryang Koh;T. Yamane;M. Yoshiyama;M. Hino
最近的报道表明，重型再生障碍性贫血患者血色素沉着症引起的心肌病在低强度异基因干细胞移植（RIST）后是可逆的。我们综合评估心脏和自主神经功能，以确定RIST后是否减轻了血色病以外原因引起的心功能不全。在5例移植前心功能不全的患者中，我们分析了移植后心脏和自主神经功能的变化，使用心电图（ECG），超声心动图，放射性核素血管造影（RNA），血清标志物和心率变异性（HRV），移植前和移植后100天。任何患者的心功能均无显著改善，ECG、超声心动图、RNA或血清标志物均无显著改变。然而，在时域分析的HRV，SD的正常到正常的RR间期（SDNN）和RR间期的变异系数（CVRR）的移植后30和60天显着下降（P = 0.04和0.01，分别）。同样，在频域分析的HRV，低频和高频功率（LF和HF）显着和暂时下降（P = 0.003和0.03，分别）。值得注意的是，在1例移植后发生急性心力衰竭的患者中，移植后30天和60天的SDNN、CVRR、r-MSSD、LF和HF值是所有患者中最低的。总之，本研究表明：（a）RIST在心功能不全患者中耐受性良好，但我们不能期望由于血色素沉着症以外的原因而改善心功能不全;（B）监测HRV可能有助于预测RIST后的心脏事件。
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.
冠心病患者贫血与低心率变异性的关系（来自“心与灵魂”研究）。
DOI：
10.1016/j.amjcard.2005.02.017
发表时间：
2005
期刊：
The American journal of cardiology
影响因子：
--
作者：
Gehi,Anil;Ix,Joachim;Shlipak,Michael;Pipkin,SharonS;Whooley,MaryA
通讯作者：
Whooley,MaryA
影响因子：
20.3
作者：
Sorror, Mohamed L.;Giralt, Sergio;Storb, Rainer
通讯作者：
Storb, Rainer
影响因子：
37.8
作者：
Narkiewicz, K;Montano, N;Somers, VK
通讯作者：
Somers, VK