DEMONSTRATION OF LATE CARDIOTOXICITY FOLLOWING BONE-MARROW TRANSPLANTATION BY ASSESSMENT OF EXERCISE DIASTOLIC FILLING CHARACTERISTICS

We evaluated the role of rest and exercise left ventricular diastolic filling parameters as a marker of cardiotoxicity in 25 consecutive pat ients 1 year following BMT. Ten age- and sex-matched subjects served a s controls. Patients were evaluated in toto and in three sub-groups ac cording to chemotherapy. Left ventricular ejection fraction (EF), peak filling rate (PFR) and time to peak filling (TTPF) were assessed at r est and at peak exercise. EF and PFR were similar at rest and at peak exercise in patients and controls. TTPF was significantly prolonged at rest in patients compared to controls (200 +/- 65 vs 131 +/- 26 ms, P = 0.003) and at peak exercise was markedly longer in patients (142 +/ - 40 vs 54 +/- 19 ms, P < 0.001). Sub-group analysis demonstrated abno rmal resting TTPF in those patients who had received either combinatio n anthracycline and CY or anthracycline and melphalan, while those pat ients who received CY alone had normal resting TTPF. However, exercise TTPF was abnormally prolonged in all patient groups. While all contro ls demonstrated a normal decrease in TTPF during exercise, four of the 25 patients had a paradoxical increase in TTPF during exercise. Exerc ise diastolic function may provide evidence of cardiotoxicity in long- term survivors of BMT.