Abstract 18994: Incidence and Predictors of Adverse Cardiovascular Outcomes in Hematopoietic Stem Cell Transplant Recipients
Introduction: Hematopoietic stem cell transplant (HSCT) has revolutionized the treatment of malignant hematologic disorders but morbidity and mortality in this population is influenced by cardiovascular complications (CVC). We examined the incidence of CVC following initial allogenic or autologous HSCT for malignant hematologic disorders in our center and identified pretransplant predictors of CVC and mortality.
Methods: We retrospectively collected data on cardiac risk factors, history of prior ischemic heart disease (IHD), arrhythmias, congestive heart failure (CHF) and pretransplant LVEF in patient’s ≥18 years undergoing their first HSCT between 1/1/2008 and 12/31/2014. Composite CVC outcomes included new CHF, asymptomatic LV systolic dysfunction, mitral regurgitation, aortic insufficiency, pericardial effusion, atrial fibrillation (AF), ventricular tachycardia, and myocardial infarction that occurred within 1 year of HSCT.
Results: There were 362 HSCT and CVC occurred in 89 (25%) in 1 year follow up (new asymptomatic decrease in LVEF by ≥10%- 26/89 and atrial fibrillation 26/89; 7.2% each, mitral regurgitation 42/89; 12%, pericardial effusion 39/89; 10.9%, new CHF 17/89; 4.7%, aortic regurgitation 2/89; 0.6%, ventricular tachycardia 3/89; 0.8%). Mean age was 53.8 ±13.0 years and 42% were obese. Compared to multiple myeloma (MM), acute and chronic leukemia and myelodysplastic syndrome (MDS) were associated with nearly 4-fold, 15-fold and 12-fold increased risk for CVC (OR 3.65, 14.80, 11.44, 95% CI 1.27 -10.49, 4.38-50.01, 3.75-34.97, p=0.012, <0.001, <0.001 respectively). Diagnosis of Leukemia or MDS, history of AF, obesity and hyperlipidemia were independently associated with CVC (p<0.05) in multivariable logistic regression models that were adjusted for age, hypertension, diabetes, pretransplant left ventricular EF, CHF and chemotherapy regimen. In addition to above variables, prior IHD and history of ventricular tachycardia were predictive of mortality.
Conclusions: Diagnosis of leukemia or MDS and cardiac risk factors such as AF and IHD are independently associated with post-transplant CVC and mortality. Increased vigilance and appropriate management by a cardiooncology service may be warranted to prevent CVC.
Author Disclosures: N.H. Aldweib: None. A. Haddad: None. M. Veer: None. G. Berteotti: None. J. Lister: None. I. Poornima: None.
- © 2016 by American Heart Association, Inc.