Serial Assessment of Cardiac Function and Morhology Using Transthoracic Echocardiography after Bone Marrow Transplatiation

Park, Chul Soo; Youn, Ho Joong; Oh, Yong Seok; Lee, Jong Min; Jeon, Hui Kyung; Cho, Eun Ju; Jung, Hae Ok; Chung, Wook Sung; Kim, Jae Hyung; Choi, Kyu Bo; Hong, Soon Jo

Abstract

PURPOSE: Bone Marrow Transplantation (BMT) is very stressful treatment to the patients' hearts. The aim of this study was to evaluate the serial change of cardiac function and morphology on echocardiography and to propose the guidelines of echocardiographic monitoring in BMT patients. METHOD: We divided the 64 patients (M:F=42:22, mean age 33+/-9, 25 AML, 8 ALL, 19 CML, 12 others) with hematologic diseases into early group (M:F=22:7, mean age=33+/-9) whose follow up echocardiograms were taken within 90 days, and late group (M:F=20:15, mean age=33+/-8) whose follow up echocardiograms were taken beyond 90 days after BMT. In both groups, changes of left ventricular dimensions, ejection fraction, wall thickness, E/A ratio and deceleration time (DT) were measured before and after BMT.
RESULTS
Cardiac complications were observed in 18 pateints after BMT. The pericardial effusion in 6, benign arrhythmias in 6, including sinus arrhythmia, premature ventricular contraction, premature atrial contraction developed in the early group, but 5 of 6 patients who had ejection fraction less than 40% were in the late group. After BMT, the thickness of interventricular septum and left ventricular posterior wall was significantly increased (p<0.05) and ejection fraction and E/A ratio was significantly decreased (p<0.05, respectively) in the early group. In the late group the thickness of interventricular septum returned to normal range, but ejection fraction was significantly decreased (p<0.05) and deceleration time significantly (p<0.05) shortened.
CONCLUSION
This study shows that the early cardiac change after BMT is mainly decrease of LV systolic function with hypertrophy and the late change is not only decrease of systolic function but also change of diastolic parameters. Therefore the serial assessment of cardiac function and morphology using transthoracic echocardiography is essential for the early diagnosis of cardiac toxicity, especially early after BMT.