Cardiac Risk Factors and Echocardiographic Variables As Predictors of Mortality in Bone Marrow Transplant Patients

The pre-Bone marrow transplant (BMT) evaluation of cardiac function by echocardiographically measured left ventricular ejection fraction (LVEF) is one of the fitness criteria. However, the data documenting the usefulness of such criteria are sparse. The aim of our study is to investigate whether pre-transplant cardiac risk factors and echocardiographic parameters could predict survival/mortality in BMT patients. We retrospectively reviewed consecutive patients undergoing BMT at our institution from January 2009 to December 2012. We compared clinical outcome in patients with regards to cardiac risk factors (history of coronary artery disease (CAD), myocardial infarction (MI), arrhythmias, Heart failure (HF), smoking, hyperlipidemia and diabetes mellitus) and multiple parameters from pre-transplant Echo. Echo variables were Left ventricular in Diastole diameter (LVIDd), Left Atrium size (LA), Left Ventricular Mass (LVM), Left ventricular mass index (LVMI), Relative wall thickness (RWT) and left ventricular geometry/remodeling. Survival was defined as months from BMT to death or the most recent follow-up. Patient's whose Echo images were of poor quality or couldn't be located in the system were excluded from the study. Of the 208 eligible patients (86 females, 41%), 121 (58%) patients underwent autologous transplant and 87 (42%) patients had an allogeneic transplant, respectively. The mean age was 56.9 years (range, 19-83 years). The prevalence of CAD, MI, CHF and history of arrhythmia in our cohort was approximately 35 (17%), 16 (7%), 16 (8%) and 17 (9%) respectively. Fourteen (7%) patients had LVEF less than 50% and 194 (93%) patients had LVEF >= 50%. History of cardiac arrhythmias showed borderline significance for association with mortality with a hazard ratio (HR) of 1.88(p=0.0534) compared to no history of arrhythmia. Patients with history of CAD and CHF showed a trend toward increased mortality, albeit did not reach statistical significance. Decreased LVEF <50% also showed a trend toward increased mortality compared to patients with normal EF with a HR of 2.025 (p = 0.0835). Other Echocardiography variables such as LVMI, RWT, Left ventricular geometry and LA size did not show any statistical correlation with mortality in BMT patients. Our results further support that BMT patients with significant cardiac risk factors are at increased risk of mortality. In particular, decreased LV ejection fraction <50% and history of arrhythmia are predictors of mortality in BMT patient. All patient's cardiac status should be well optimized prior to transplant.