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Tissue doppler echocardiography detects preclinical markers of cardiac lesion in MDS patients

Abstract

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder of elderly people. Cardiac dysfunction is a marker of grim prognosis in MDS. We evaluated cardiac dysfunction of MDS patients with or without transfusion dependency by tissue doppler echocardiography. We found the average values of ventricular end-systolic and end-diastolic volumes in transfusion dependency MDS group higher than others. These results were strongly correlated to hemoglobin levels. Tissue Doppler Echocardiography should be routinely performed in MDS patients to detect preclinical cardiac alterations and prevent more heart insults in this group of chronic anemic aged patients.

To the Editor

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder and anemia with transfusion dependency is detected in up to 60% of patients [1]. Early recognition of patients at risk of heart failure is difficult because global ventricular function and exercise capacity in chronically transfused patients may remain normal until late in the disease [2].

We evaluated three groups of MDS patients: cases with transfusion dependency (T-MDS), patients without transfusion dependency (NT-MDS) and age-matched controls. Transfusion dependency was considered as reported by Malcovati et al. [3]. Echo-Doppler, tissue velocity imaging and strain measures were obtained using General Electric-Healthcare (GE, Vivid-7) system with a matrix probe M3S.

Parametric data were analyzed by “one-way” analyzes of variance (ANOVA) with Bonferroni’s Multiple Comparison as a post-test. Non-parametric data were analyzed by Kruskal-Wallis. The studies of correlation was assessed by Pearson’s correlation coefficient (r).

The three groups were composed of 13 T-MDS, 21 NT-MDS and 14 controls. There were no significant differences between groups. See Table 1. Table 2 presents the echocardiographic parameters. The average values of ventricular end-systolic and end-diastolic volumes in T-MDS group were significantly higher than NT-MDS and controls (p <0.05 and p <0.04 respectively). The left atrial volume indexed (LAV index) was significantly larger in patients of T-MDS group than NT-MDS and controls (35.9 ± 15 mL/m2, 26.6 ± 5,2 mL/m2, 22.8 ± 8 mL/m2 respectively) (p <0.004.). A strong correlation between hemoglobin levels and LVEDV (left ventricular end-diastolic volume), LVESV (left ventricular end-systolic volume), LAV (left atrial volume) and LAV index was observed, with r values of −0.4, -0.4, -0.53 and 0.51 respectively (p <0.02, p <0.02, p <0.002 and p <0.002 respectively). See Figure 1. Otherwise, we found no correlation between ferritin levels and echocardiographic parameters.

Table 1 Patients were diagnosed and classified according to WHO, IPSS and WPSS criteria
Table 2 Echocardiographic parameters of patients and controls
Figure 1
figure1

Linear correlation between left cardiac volumes and values of hemoglobin. A. LAV: left atrial volume. B. LVEDV: left ventricular end-diastolic volume; C. LAV index : left atrial volume index. D. LVESV: left ventricular end-systolic volume.

The reduction of blood viscosity in severe anemia increases blood return [4] and ventricular preload which lead to atrial and ventricular enlargement observed in T-MDS patients. Confirming this hypothesis, these results are correlated to hemoglobin levels.

The T-MDS group showed no clinical sign of cardiac dysfunction. Otherwise, cardiac alterations were detected by tissue-doppler echocardiography, a relative fast and cheap bedside method to evaluate heart function. Echocardiography should be routinely performed in MDS patients to detect preclinical cardiac alterations and prevent more heart insults in these group of chronic anemic aged patients.

Abbreviations

NT-MDS:

Non-transfused patients

T-MDS:

Transfused patients

LVDD:

Left ventricular diastolic diameter

LVSD:

Left ventricular systolic diameter

IVS:

Inter-ventricular septum

LVPW:

Left ventricular posterior wall

LVEDV:

Left ventricular end-diastolic volume

LVESV:

Left ventricular end-systolic volume

LAV:

Left atrial volume

RCC:

Red cell concentrate

VD:

Ventricular dysfunction.

References

  1. 1.

    Cazzola M, Della Porta MG, Travaglino E, Malcovati L: Classification and prognostic evaluation of myelodysplastic syndromes. Semin Oncol. 2011, 38 (Suppl 5): 627-634.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Naqvi K, Garcia-Manero G, Sardesai S, Oh J, Vigil CE, Pierce S, Lei X, Shan J, Kantarjian HM, Suarez-Almazor ME: Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model. J Clin Oncol. 2011, 29: 2240-2246. 10.1200/JCO.2010.31.3353.

    PubMed Central  Article  PubMed  Google Scholar 

  3. 3.

    Malcovati L, Porta MG, Pascutto C, Invernizzi R, Boni M, Travaglino E, Passamonti F, Arcaini L, Maffioli M, Bernasconi P, Lazzarino : Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol. 2005, 20 (Suppl 30): 7594-7603.

    Article  Google Scholar 

  4. 4.

    Carmer R: Anemia and aging: an overview of clinical, diagnostic and biological issues. Blood Rev. 2001, 15: 9-18. 10.1054/blre.2001.0146.

    Article  Google Scholar 

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Acknowledgements

Support by CAPES CNPq and FUNCAP.

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Correspondence to Ronald F Pinheiro.

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The authors declare that they have no competing interests.

Authors’ contributions

CCMC was the principal investigator and takes primary responsibility for the paper. CBGG provide technical support. MRAM participated in the statistical analysis. JCS performed the laboratory work for this study and edited the manuscript. SMMM provided critical revision. RFP coordinated the research and wrote the paper.

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de Castro, C.C.M., Gondim Gomes, C.B., Martins, M.R.A. et al. Tissue doppler echocardiography detects preclinical markers of cardiac lesion in MDS patients. J Hematol Oncol 5, 30 (2012). https://doi.org/10.1186/1756-8722-5-30

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Keywords

  • Myelodysplastic syndrome
  • Comorbidity
  • Cardiac dysfunction