Eames G M, Crosson J, Steinberger J, Steinbuch M, Krabill K, Bass J, Ramsay N K, Neglia J P
Department of Pediatrics, University of Minnesota, School of Medicine, Minneapolis, USA.
Bone Marrow Transplant. 1997 Jan;19(1):61-6. doi: 10.1038/sj.bmt.1700600.
Sixty-three patients who had undergone a BMT at age < or = 18 years were evaluated cross-sectionally to determine cardiac function as well as the long-term prevalence, types, severity, and risk factors of cardiac abnormalities. Patients were > or = 1 year post-BMT and were evaluated by history, resting ECG, echocardiography (ECHO), exercise treadmill test, chest X-ray, pulmonary function tests and review of past cardiac studies. Patients were assigned a New York Heart Association (NYHA) class based on an activity and cardiac symptoms questionnaire. Pretransplant preparative regimens included high-dose cyclophosphamide (CY) and total body/lymphoid irradiation (n = 38), CY in combination with other chemotherapy (n = 22), and other drug combinations (n = 3). Forty patients (63.5%) had received prior anthracyclines (median 307 mg/m2). Patients' ages ranged from 1.9 to 32 years (median 10.9 years) with median follow-up of 3.3 years (range 1-16.3 years). Twenty-six patients (41.3%) had a cardiac abnormality detected at follow-up. In 21 patients the abnormal finding had not been present at the pre-BMT evaluation. Ten patients (16.4%) had resting ECG abnormalities. Left ventricular ejection fraction (LVEF) by ECHO was mildly decreased to 50-54% in three patients and markedly decreased to 40% in one patient. Only one patient (1.7%) developed a mildly abnormal shortening fraction of 27%. All patients with ECHO abnormalities were asymptomatic. Twenty-three of 31 patients > or = 9 years of age (74%) who underwent a treadmill exercise test had a borderline or abnormal response to exercise. There was no correlation between demographic factors, previous therapy, preparative regimen or length of follow-up with the post-BMT ECG, ECHO and treadmill abnormalities. Overall, eight patients (12.7%) were symptomatic and NYHA class II or III, and all had abnormal exercise tests. The presence of symptoms and NYHA class were predictors for oxygen consumption during exercise (P = 0.03 and 0.02, respectively) and tended to predict overall treadmill results also. Late cardiac abnormalities do occur following BMT in childhood and thus, there is a clear need for continued, serial long-term cardiac evaluation in transplant survivors. Evaluations should include exercise stress testing to detect inadequate cardiac output as well as oxygen consumption during exercise.
对63例18岁及以下接受过骨髓移植（BMT）的患者进行了横断面评估，以确定心脏功能以及心脏异常的长期患病率、类型、严重程度和危险因素。患者在BMT后1年及以上，通过病史、静息心电图、超声心动图（ECHO）、运动平板试验、胸部X线、肺功能测试以及回顾既往心脏检查进行评估。根据活动和心脏症状问卷为患者分配纽约心脏协会（NYHA）分级。移植前预处理方案包括大剂量环磷酰胺（CY）和全身/淋巴照射（n = 38）、CY联合其他化疗（n = 22）以及其他药物组合（n = 3）。40例患者（63.5%）曾接受过蒽环类药物治疗（中位剂量307 mg/m²）。患者年龄范围为1.9至32岁（中位年龄10.9岁），中位随访时间为3.3年（范围1至16.3年）。26例患者（41.3%）在随访时检测到心脏异常。21例患者在BMT前评估时未发现异常。10例患者（16.4%）有静息心电图异常。ECHO检测的左心室射血分数（LVEF）在3例患者中轻度降至50 - 54%，1例患者中显著降至40%。仅1例患者（1.7%）出现轻度异常的缩短分数为27%。所有ECHO异常的患者均无症状。31例年龄≥9岁的患者中，23例（74%）进行了运动平板试验，其中部分患者运动反应临界或异常。人口统计学因素、既往治疗、预处理方案或随访时间与BMT后心电图、ECHO及运动平板异常之间无相关性。总体而言，8例患者（12.7%）有症状且为NYHA II级或III级，且所有患者运动试验均异常。症状的存在和NYHA分级是运动时耗氧量的预测因素（分别为P = 0.03和0.02），也倾向于预测运动平板试验的总体结果。儿童BMT后确实会出现晚期心脏异常，因此，移植幸存者显然需要持续进行系列长期心脏评估。评估应包括运动负荷试验，以检测心输出量不足以及运动时的耗氧量。
