Predictive value of left ventricular ejection fraction in stem cell transplantation

We evaluated predictive value of left ventricular ejection fraction at rest (REF) and its increment with exercise (Delta EF) on autologous and allogen eic stem cell transplantation mortality. In a 7 year period, a total of 163 patients evaluated for stem cell transplantation were studied. All were fo llowed for at least 3 months after the transplant. REF was discriminatory f or peritransplant mortality only in younger (<43 years) patients (n = 66), particularly those who underwent autologous transplantation (n = 30), Resti ng ejection fraction was not a discriminator for early death in any other s ubgroup. Cardiac reserve (Delta EF) was significantly lower in patients (n = 35), who died early. The finding was most prominent in younger patients w ho underwent autologous transplantation (n = 26). Combination of decreased REF and low Delta EF (n = 18) was associated with high peritransplant morta lity (56%), after both autologous and allogeneic transplantation. A low REF with an appropriate Delta EF (n = 43) was associated with a 19% peritransp lant mortality and no deaths in the autologous group. These observations in dicate that resting ejection fraction is of only limited value for pretrans plant evaluation. However, measurement of cardiac reserve during exercise c an provide important prognostic information before stem cell transplantatio n.