Pretransplant-corrected QT dispersion as a predictor of pericardial effusion after pediatric hematopoietic stem cell transplantation

Abstract

SummaryPericardial effusion is a potentially fatal complication following hematopoietic stem cell transplantation (HSCT). Therefore, the identification of risk factors could improve the outcome. Prolonged QT dispersion (QTD) and corrected QTD (QTcD) are associated with serious arrhythmias and sudden death in many forms of heart disease. However, no study has evaluated the efficacy of QTD and QTcD to predict pericardial effusion post-HSCT. We studied 89 pediatric HSCT patients to identify preoperative risk factors for pericardial effusion with particular focus on QTD and QTcD. Pericardial effusion occurred in 15 patients (cumulative onset rate: 17.4%) within one year post-HSCT, of which 8 (9.2%) were symptomatic. Patients with pericardial effusion following allogeneic HSCT showed significantly lower overall survival; however, pericardial effusion was not the direct cause of death in any patient. Univariate and multivariate analyses revealed that transplantation-associated thrombotic microangiopathy (TA-TMA) was an independent risk factor for post-HSCT pericardial effusion. In addition, pretransplant QTcD was significantly prolonged in the pericardial effusion group. These results suggest that pediatric patients with abnormally prolonged QTcD before the preparative regimen for HSCT should be regularly followed-up by echocardiography to detect pericardial effusion, particularly when accompanied by complications including TA-TMA.

New approaches in the diagnosis, pathophysiology, and treatment of pediatric hematopoietic stem cell transplantation-associated thrombotic microangiopathy

“…Pericardial effusion has been strongly associated with TA-TMA in HSCT patients [33,34]. Pericardial effusion can be suspected on chest X-ray or may be detected on echocardiographic screening even in asymptomatic patients.…”

Predictive factors of poor blood collecting flow during leukocyte apheresis for cellular therapy

“…QT dispersion was analyzed using the method described previously [12,21,22]. Briefly, we evaluated a standard 12-lead electrocardiogram taken before leukocyte apheresis.…”

Pericardial effusion: The key point is the underlying etiology. Authors’ reply

“…In this letter, the authors stated that "Pericardial effusion is well known to make changes in the electrocardiogram. Moreover, Yanagisawa et al [4] found the relationship between pericardial effusion and QT dispersion. Also, Oliva et al [5] found T wave changes in patients with pericardial effusion."…”

“…In the first study, Yanagisawa et al [4] noted that pericardial effusion is a potentially fatal complication following hematopoietic stem cell transplantation (HSCT). Common causes of pericardial effusion after HSCT were the reaction to allogeneic HSCT, the conditioning regimen, graft-versushost disease, infection, primary disease relapse, iron overload, and reaction to sirolimus or any immunosuppressant.…”

“…Common causes of pericardial effusion after HSCT were the reaction to allogeneic HSCT, the conditioning regimen, graft-versushost disease, infection, primary disease relapse, iron overload, and reaction to sirolimus or any immunosuppressant. In this analysis, Yanagisawa et al [4] evaluated the efficacy of QT dispersion and corrected QT dispersion to predict pericardial effusion after HSCT. Their results suggest that pediatric patients with abnormally prolonged corrected QT dispersion before the preparative regimen for HSCT should be regularly followed-up by echocardiography to detect pericardial effusion, especially when accompanied by complications including transplantation-associated thrombotic microangiopathy.…”