Section of Cardiology, Department of Medicine, UChicago Medicine, Chicago, IL 60636, USA.
Section of Hematology/Oncology, Department of Medicine, UChicago Medicine, Chicago, IL 60637, USA.
Int J Cardiol. 2021 Sep 15;339:225-231. doi: 10.1016/j.ijcard.2021.06.038. Epub 2021 Jun 23.
Atrial arrhythmias following hematopoietic stem cell transplantation (HSCT) have been associated with increased length of stay, need for intensive care, and increased mortality within one-year post-transplant. We sought to identify echocardiographic parameters that may predict the development of new atrial arrhythmias post-HSCT.
We performed a retrospective chart review of 753 consecutive patients who underwent HSCT at the University of Chicago from January 2015 through December 2019. Patients with baseline echocardiogram within 6 months prior to transplantation were included. Those with prior transplants, history of atrial arrhythmias, or unavailable echocardiographic images were excluded, resulting in 187 patients included for final analysis. Baseline clinical and demographic variables, as well as echocardiographic parameters, were compared between patients who developed new atrial arrhythmias post-HSCT versus those who did not.
Of the 187 patients included for analysis, 25 (13%) developed new atrial arrhythmias, with 13 of these occurring within 30 days of transplantation. Despite no significant difference in left atrial (LA) end-systolic volume between those with and without new arrhythmia following HSCT (OR 1.04; 95% CI 0.91-1.09, p = 0.233), univariable analysis demonstrated that patients who developed atrial arrhythmias had reduced LA function, as reflected by lower LA emptying fraction (OR 0.94; 95% CI 0.91-0.98, p = 0.003) and lower LA reservoir strain (OR 0.95; 95% CI 0.92-0.99, p = 0.009).
Echocardiographic indices of LA function, namely LA emptying fraction and LA reservoir strain, can identify patients at risk for developing new atrial arrhythmias post-HSCT, prior to the development of morphologic changes in the LA.
造血干细胞移植（HSCT）后发生的房性心律失常与移植后一年内住院时间延长、需要重症监护和死亡率增加有关。我们试图确定超声心动图参数，这些参数可能预测 HSCT 后新发房性心律失常的发生。
我们对 2015 年 1 月至 2019 年 12 月在芝加哥大学接受 HSCT 的 753 例连续患者进行了回顾性图表审查。纳入了移植前 6 个月内有基线超声心动图的患者。排除了有既往移植、房性心律失常病史或无法获得超声心动图图像的患者，最终纳入 187 例患者进行最终分析。比较了 HSCT 后新发房性心律失常的患者与未发生的患者的基线临床和人口统计学变量以及超声心动图参数。
在纳入分析的 187 例患者中，有 25 例（13%）发生新发房性心律失常，其中 13 例发生在移植后 30 天内。尽管 HSCT 后新发心律失常的患者与无新发心律失常的患者左心房（LA）收缩末期容积无显著差异（比值比 1.04；95%置信区间 0.91-1.09，p=0.233），但单变量分析表明，发生心律失常的患者的 LA 功能降低，表现为 LA 排空分数降低（比值比 0.94；95%置信区间 0.91-0.98，p=0.003）和 LA 储备应变降低（比值比 0.95；95%置信区间 0.92-0.99，p=0.009）。
LA 功能的超声心动图指数，即 LA 排空分数和 LA 储备应变，可在 LA 形态改变之前识别出 HSCT 后发生新发房性心律失常的患者。
