The analysis of the parameters of 24‐hr <scp>ECG</scp> Holter monitoring in patients with blood neoplasms undergoing high‐dose chemotherapy and stem cell transplantation

Aims Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. Methods and results The National Inpatient Sample (2016–19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9–3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55–5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6–2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54–7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17–18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56–4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79–3.55; P < 0.001) and cost of care (+67 529; 36 630–98 427; P < 0.001). Conclusion Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.

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“… 23 , 24 Whether these patients would benefit from longitudinal rhythm monitoring is debatable. 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation

et al. 2023

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“…It is known that arrhythmias, when they happen, may precede the forthcoming cardiac pathology as cardiomyopathy or heart failure also as a complication due to cardiotoxicity. From this point of view, 24-h Holter monitoring should be recommended routinely at peri-transplant period as we suggested in our previous paper [ 15 ]. Generally, arrhythmias occur in patients who had the procedure of HSCT in about 7–9% of patients, ranging from 1 to 27%, depending on the methods of evaluation, especially in subjects with a pre-existing cardiovascular disease or with smoking habit [ 15 , 45 – 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…From this point of view, 24-h Holter monitoring should be recommended routinely at peri-transplant period as we suggested in our previous paper [ 15 ]. Generally, arrhythmias occur in patients who had the procedure of HSCT in about 7–9% of patients, ranging from 1 to 27%, depending on the methods of evaluation, especially in subjects with a pre-existing cardiovascular disease or with smoking habit [ 15 , 45 – 47 ]. However, in our former study, we commented that there are more electrocardiographic pathologies in such a population of patients, but previous publications concentrated mainly on more severe arrhythmias like ventricular tachycardia or atrial fibrillation.…”

Section: Discussionmentioning

confidence: 99%

“…However, in our former study, we commented that there are more electrocardiographic pathologies in such a population of patients, but previous publications concentrated mainly on more severe arrhythmias like ventricular tachycardia or atrial fibrillation. We have found more different pathologies including atrio-ventricular blocks and premature beats and, eventually, we noted various changes increasing in up to 41.07% of patients after HSCT [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…A study group of patients was selected from the candidates to high-dose chemotheraphy with consecutive HSCT, included to the project entitled: “The evaluation of the early cardiotoxicity of high-dose chemotherapy and hematopoietic stem cells transplantation in patients with blood neoplasms”. Inclusion and exclusion criteria and the characteristics of the population participating in the project were presented in a the former publication of the authors [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies

et al. 2018

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High-dose chemotherapy (HDC) followed by stem cell transplantation (HSCT) is a well-established method in patients with hematological malignancies, and for last few years, many efforts have been made to estimate short- and long-term efficacy of this method, as well as early and late complications. The present study concentrates on cardiotoxic effects, mainly early changes using biochemical markers such as N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn). Simultaneously, the analysis of 12-lead ECG was done before and after the procedure in which the novel repolarization markers: Tp–e and Tp–e/QT ratio were measured, together with standard markers: QT, QTc. It was found that NT-pro BNP was significantly increased after HSCT in comparison to results before it, and no significant changes were present in Troponin levels. Simultaneously, Tp–e interval and Tp–e/QT ratio were significantly higher after HSCT. The use of cyclophosphamide, advanced age, and higher level of blood cholesterol concentration were risk factors for the increase in NT-proBNP and treatment with cyclophosphamide as well as fludarabine and higher creatinine levels were risk factors for the increase in Tp–e/QT ratio. In conclusion, in the early term evaluation after HSCT in patients with no previously diagnosed heart disease, the mild changes in markers of heart overload and repolarization were noted. The observations suggest that in all patients undergoing HSCT, even the ones without pre-existing cardiovascular disease, the evaluation, and monitoring of heart function should be considered.

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Association of persistent tachycardia with early myocardial dysfunction in children undergoing allogeneic hematopoietic cell transplantation

Goldberg

Peters

Tolley

et al. 2021

Bone Marrow Transplant

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The analysis of the parameters of 24‐hr ECG Holter monitoring in patients with blood neoplasms undergoing high‐dose chemotherapy and stem cell transplantation

Abstract: In patients with blood neoplasms undergoing HSCT more electrocardiographic abnormalities may be found after this procedure in comparison with the 24-hr Holter monitoring before transplantation.

Cited by 6 publications

References 36 publications

Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation

Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation

Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies

Association of persistent tachycardia with early myocardial dysfunction in children undergoing allogeneic hematopoietic cell transplantation

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