Cardiac Complications of Marrow Transplantation

Abstract

Cardiac complications are common, but usually subclinical, after blood and marrow transplantation. The most frequent causes of serious, life-threatening cardiac complications, such as severe heart failure, effusive pericarditis, and arrhythmias, are regimen-related toxicities due to cyclophosphamide and ifosfamide. These are most common in the presence of pre-existing anthracycline cardiac toxicity. Patients with baseline ejection fractions less than 50% have a higher incidence of cardiac toxicity. Radiation and other transplant-associated agents (etoposide, taxol, etc.) are known to have potential, but less frequent, cardiac toxicities. It may be clinically difficult to distinguish cardiac problems from other processes, such as pulmonary toxicity, volume overload, or sepsis-related myocardial depression. Additionally, pericardial, myocardial, and valvular infections are potential, rare causes of complications and may pose diagnostic challenges. While there is no consensus regarding the pre-transplant evaluation of left ventricular function, general guidelines for management issues, both before and after transplant, can be made.