Changes And Clinical Significance Of Heart Remodeling And Function In Patients With Myeloproliferative Neoplasms

ObjectiveThe aims of our study were to explore the characteristics of cardiac structure and functional changing in patients with MPN through application of echocardiography.MethodsPatients with MPN were enrolled in Beijing Anzhen Hospital from Sep 2011 to Sep 2016 and their clinical data and the result of echocardiography were collected.Control group were concurrent patients from non-Department of Hematology,and their gender,age and major cardiovascular risk factors including course of disease and treatment were matched with MPN patients.Through the comparisons of echocardiographic parameters between MPN group and control group,to analyze the possible reasons between the changes of cardiac remodeling and function in MPN patients and clinical features such as blood cell count,JAK2 V617 F gene mutation and course.Results1.The WBC,Neu,Bas,Mon,RBC,Hct,Hb and Plt counts in MPN group were significantly higher than that in control group(P<0.05).There were no differences in age,gender,hs-CRP,TG,HDL,LDL and major cardiovascular risk factors between the two groups(P>0.05).2.Left atria diameter in MPN group was significantly higher than that in control group[(37.60±6.64)mm vs(35.01±4.37)mm](P=0.016).Left ventricular diastolic dimension,left ventricular systolic diameter,right ventricular diameter,aortic root diameter and pulmonary artery systolic pressure in MPN group were higher than these in control group(P<0.05);left ventricular ejection fraction was lower than that in control group(P<0.05),but all of these average value were in normal range.3.The proportion of abnormal cardiac structure in MPN group was higher than that in control group(54.17%vs32.29%)(P < 0.05).And left ventricle hypertrophy(34.38%),aortic valve degeneration(27.08%)and left cardiac dilatation(12.50%)were the most common,the rate of which was significantly higher than that in control group(17.71%;11.45%;4.17%)(P<0.05).The proportion of 2 and more than 3 items of abnormal cardiac structure events in MPN group was significantly higher than that in control group(17.71%vs 6.25%;5.21% vs 0%)(P<0.05).4.The proportion of abnormal cardiac function in MPN group was higher than that in control group(81.25%vs64.58%,P < 0.05).And left ventricle diastole dysfunction(75%),pulmonary arterial hypertension(11.45%)and left ventricular contractile dysfunction(12.50%)were the most common.The rate of PAH and left ventricular contractile dysfunction were significantly higher than that in control group(0%;2.08%)(P<0.05).The proportion of 2 items of abnormal cardiac function events in MPN group was significantly higher than that in control group(16.67%vs 2.08%,P<0.05)5.Simple correlation analysis: Left ventricular diastolic dimension in patients with MPN was positively correlated with red blood cell,hematocrit,hemoglobin(r=0.281,P=0.001;r=0.374,P=0.000;r=0.343,P=0.000).Left ventricular systolic dimension in patients with MPN was positively correlated with red blood cell,hematocrit,hemoglobin(r=0.203,P=0.013;r=0.330,P=0.000;r=0.334,P=0.000).Right ventricular diameter in patients with MPN was positively correlated with red blood cell,Hct,hemoglobin(r=0.268,P=0.001;r=0.291,P=0.001;r=0.312,P=0.000).Multiple factors analysis: a logistic regression analysis showed that the increased count of Hct and Hb were independently risk factors for MPN with aortic valve degeneration(?=0.436,OR=1.229;?=0.186,OR=0.831).6.Left atria diameter in long-course group above five years was significantly higher than that in short-course group[(39.69±7.55)mm vs(36.43±5.82)mm,P <0.05].And pulmonary arterial hypertension was more common in long-course group above five years compared to short-course group(20.00% vs 6.56%,P<0.05).Conclusions1.Patients with MPN can be found abnormal cardiac structure and function,wich mainly shows that left atrium diameter significantly increased,left ventricular hypertrophy,degeneration of the aortic valve,PAH,left ventricular contractile dysfunction.2.The changes of left ventricular diastolic diameter and left ventricular systolic diameter are related to the level of first diagnosis RBC,Hct and Hb.And right ventricular diameter are related to the level of first diagnosis red blood cell,Hct and Hb.The increased count of Hct and Hb was independently risk factor for MPN with aortic valve degeneration.3.MPN is likely to ocur a variety of abnormal cardiac structure and function more easily,and patients with more long course of the disease are more prone to have heart structure and function changes.