Kohko Kanazawa1, Masumi Iwai-Takano2,3,4, Satoru Kimura5, Tetsuya Ohira2. 1. Division of Cardiology, Ohta Nishinouchi Hospital, 2-5-20, Nishinouchi, Koriyama, 963-8022, Japan. kohko-k@fmu.ac.jp. 2. Department of Epidemiology, Fukushima Medical University, Fukushima, Japan. 3. Fukushima Prefectural General Hygiene Institute, Fukushima, Japan. 4. Division of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan. 5. Division of Hematology, Ohta Nishinouchi Hospital, Koriyama, Japan.
Abstract
PURPOSE: Tacrolimus (TAC) is used for the prophylaxis and treatment of acute graft-versus-host disease after bone marrow transplantation (BMT). However, few have reported on TAC-induced left ventricular hypertrophy. This study aimed to assess the relationship between blood concentration of TAC and development of TAC-induced left ventricular (TI-LV) dysfunction in adult BMT patients with hematologic malignant diseases, and to evaluate whether TAC concentration can predict TI-LV dysfunction occurrence in these patients. METHODS: We enrolled 16 consecutive patients (mean age 44.6 ± 13.0 years) who received TAC after BMT. Echocardiography was performed before and after BMT, and blood concentrations of TAC were evaluated in terms of AUC15 (area sum of TAC > 15 ng/ml during follow-up). We assessed the relationship between AUC15 and development of TI-LV dysfunction after TAC. RESULTS: During the follow-up period (mean duration 47.6 ± 13.7 days), interventricular septum thickness (IVST, P = 0.001) and posterior wall thickness (PWT, P < 0.001) increased, and E' decreased (P = 0.006). AUC15 was associated with post-IVST (R = 0.627, P = 0.009), post-PWT (R = 0.669, P = 0.005), and post-E' (R = - 0.767, P = 0.001). In multivariate analysis, AUC15 and age independently predicted the increase in IVST and PWT and decrease in E' after BMT. The combination of AUC15 and older age predicted post-PWT with a sensitivity of 77.8% and specificity of 71.4%. CONCLUSION: TAC concentrations should be maintained at < 15 ng/ml and age should be considered in patients undergoing BMT to avoid TI-LV dysfunction.
PURPOSE:Tacrolimus (TAC) is used for the prophylaxis and treatment of acute graft-versus-host disease after bone marrow transplantation (BMT). However, few have reported on TAC-induced left ventricular hypertrophy. This study aimed to assess the relationship between blood concentration of TAC and development of TAC-induced left ventricular (TI-LV) dysfunction in adult BMT patients with hematologic malignant diseases, and to evaluate whether TAC concentration can predict TI-LV dysfunction occurrence in these patients. METHODS: We enrolled 16 consecutive patients (mean age 44.6 ± 13.0 years) who received TAC after BMT. Echocardiography was performed before and after BMT, and blood concentrations of TAC were evaluated in terms of AUC15 (area sum of TAC > 15 ng/ml during follow-up). We assessed the relationship between AUC15 and development of TI-LV dysfunction after TAC. RESULTS: During the follow-up period (mean duration 47.6 ± 13.7 days), interventricular septum thickness (IVST, P = 0.001) and posterior wall thickness (PWT, P < 0.001) increased, and E' decreased (P = 0.006). AUC15 was associated with post-IVST (R = 0.627, P = 0.009), post-PWT (R = 0.669, P = 0.005), and post-E' (R = - 0.767, P = 0.001). In multivariate analysis, AUC15 and age independently predicted the increase in IVST and PWT and decrease in E' after BMT. The combination of AUC15 and older age predicted post-PWT with a sensitivity of 77.8% and specificity of 71.4%. CONCLUSION: TAC concentrations should be maintained at < 15 ng/ml and age should be considered in patients undergoing BMT to avoid TI-LV dysfunction.
Entities:
Keywords:
Adult; Bone marrow transplantation; Echocardiography; Hematologic malignant disease; Tacrolimus-induced left ventricular dysfunction
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