Heart Rate Variability and Heart Rate Turbulence in Patients with Hematologic Malignancies Subjected to High-Dose Chemotherapy in the Course of Hematopoietic Stem Cell Transplantation

• Published in: Annals of noninvasive electrocardiology 2014-03, Vol.19 (2), p.157-165
• Main Authors: Poręba, Małgorzata, Poręba, Rafał, Gać, Paweł, Usnarska-Zubkiewicz, Lidia, Pilecki, Witold, Piotrowicz, Ewa, Piotrowicz, Ryszard, Rusiecki, Leszek, Kuliczkowski, Kazimierz, Mazur, Grzegorz, Sobieszczańska, Małgorzata
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Bone marrow; cardiotoxicity; Chemotherapy; Cholesterol - blood; Combined Modality Therapy; Electrocardiography, Ambulatory - methods; Female; Heart; Heart rate; Heart Rate - drug effects; heart rate turbulence; heart rate variability; Hematologic Neoplasms - blood; Hematologic Neoplasms - drug therapy; Hematologic Neoplasms - surgery; Hematology; hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - methods; high-dose chemotherapy; Humans; Leukemia - blood; Leukemia - drug therapy; Leukemia - surgery; Lymphoma - blood; Lymphoma - drug therapy; Lymphoma - surgery; Male; Multiple Myeloma - blood; Multiple Myeloma - drug therapy; Multiple Myeloma - surgery; Original; Risk Factors; Stem cells; Transplants & implants; Turbulence
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/anec.12108

Background In hematological malignancies, remissions and cures may be achieved by hematopoietic stem cell transplantation (HSCT) following high‐dose chemotherapy (HDC). Cardiotoxicity of such therapy has not yet been fully elucidated. Noninvasive approaches allowing to evaluate an autonomic control of the heart function include analyses of both heart rate variability (HRV) and heart rate turbulence (HRT). Methods In 38 patients with hematological malignancies, 24‐hour electrocardiography Holter monitoring , with HRV and HRT analysis before HSCT (A test) and after HSCT (B test), was performed. Results The 24‐hour analysis of HRV demonstrated that SDNN, SDNNi, rMSSD, and pNN50 parameters were significantly lower after HSCT as compared to the results obtained before the transplantation (P < 0.05). For period of diurnal activity and for night hours, SDANN, SDNNi, rMSSD, and pNN50 were significantly lower in B test, as compared to the results of A test (P < 0.05). The analysis of HRT demonstrated that turbulence onset parameter was significantly higher, and turbulence slope parameter was significantly lower in B test, as compared to A test (P < 0.05). The multifactorial stepwise backward regression analysis indicated that administration of cyclophosphamide and carmustine and higher concentrations of blood cholesterol represented risk factors for decreased HRV. Cyclophosphamide and higher triglyceride levels represented independent risk factors for decreased HRT. Conclusions In patients with hematopoietic malignancies treated with HSCT, decreased HRV and HRT were observed after chemotherapy and stem cells administration.