Prevalence of cardiovascular risk factors and diseases in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation
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Deborah Backs1,2,3, Ilknur Saglam1,2, Claudia Löffler4, Sandra Ihne4, Caroline Morbach1,2, Susanne Brenner1,2, Christiane Angermann1, Georg Ertl1, Stefan Frantz1,2, Stefan Störk1,2, Stefan Knop4 and Gülmisal Güder1,2
1 Comprehensive Heart Failure Center Würzburg, University of Würzburg, Würzburg, Germany
2 Department of Internal Medicine I, Division of Cardiology, University Hospital of Würzburg, Würzburg, Germany
3 Department of Medicine II, Division of Cardiology, University Hospital of Schleswig-Holstein, Lübeck, Germany
4 Department of Internal Medicine II, Division of Hematology, University Hospital of Würzburg, Würzburg, Germany
Keywords: cardiovascular risk factors; cardiovascular diseases; multiple myeloma; arterial hypertension; echocardiography
Received: February 18, 2019 Accepted: April 03, 2019 Published: May 07, 2019
Multiple myeloma (MM) is the second most common hematologic malignancy and occurs similar to cardiovascular diseases (CVD), in the sixth/seventh decade. The aim of this retrospective cohort study was to evaluate the prevalence and prognostic value of cardiovascular risk factors (CVRF) and CVD in 325 patients with MM undergoing autologous peripheral blood stem cell transplantation (PBSCT) at the University Hospital of Würzburg between 03/2004 and 12/2011. Mean age in the total cohort was 61 years. Among CVRF, prevalence of arterial hypertension was highest (59.7%), followed by overweight (54.2%) and positive smoking history (18.2%). The prevalence of heart failure (3.1%) or coronary heart disease (4.8%) was low. During a median follow-up of 36 months, 18% of the patients died. Hypertension (HR = 1.83, p = 0.048) as well as positive smoking history (HR = 2.13, p = 0.02) were independently associated with increased mortality risk in multivariate analysis. In a subgroup analysis of 100 patients echocardiographic parameters were compared before and after PBSCT. Echocardiography revealed a significant reduction of left atrial diameters (–1.5 mm, p = 0.009) and septum thickness (–1.0 mm, p = 0.001), non-significant reduction of systolic function, and an increase of the prevalence of diastolic dysfunction (+14%; p = 0.01). In this study CVRF, especially hypertension and smoking, are strong predictors of poor survival in patients with MM undergoing autologous PBSCT. Echocardiography before and after treatment shows subtle changes in systolic function but an increase of the prevalence of diastolic dysfunction.
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