To evaluate a prognostic effect of echocardiographic parameters, we retrospectively collected and analyzed echocardiographic and epidemiologic data from 599 patients who underwent alloSCT at the Heidelberg University Hospital between March 2002 and June 2018. These patients underwent echocardiography 27 days (median) prior alloSCT. 

Patients with LVEF ≤ 40% before alloSCT had a significantly lower five-year all-cause mortality (ACM) (log-rank test, p < 0.001). Notably, a cutoff of LVEF ≤ 50% did not discriminate patients in terms of mortality (log-rank test, p = 0.88). The same pattern (LVEF ≤ 40%, log-rank test, p < 0.01; LVEF ≤ 50%, log-rank test, p < 0.46) was observed when analyzing Non-relapse mortality (NRM). Comparing the prognostic value of other echocardiographic parameters, cardiovascular risk factors (smoking status, hyperlipidemia, diabetes and arterial hypertension (aHT)), history of prior cardiac diseases an increased posterior wall thickness (PW) ≥ 10mm correlated in univariable Cox regression with reduced 5-year ACM (logistic regression, p = 0.016) as well as a reduced LVEF ≤ 40% (logistic regression, p = 0.003). Both, LVEF and PW, were independent predictors in a multivariate analysis (LVEF ≤ 40%: p = 0.007; PW: p = 0.016). 

High-intensity myeloablative conditioning (MAC) prior to alloSCT could potentially associate with more cardiac complications than reduced intensity conditioning (RIC). Therefore, we selected patients who received RIC (n = 478) and used shorter time periods of NRM (one and two years) after alloSCT as endpoints in logistic regression analyses. In these patients, cardiac hypertrophy was again a predictor for mortality (posterior wall and hypertrophic septum), in contrast to LVEF (logistic regression, PW: p = 0.007, LVEF ≤ 40%, p = 0.08, Septum ≥11mm: p = 0.02). Interestingly, cardiovascular risk factors (aHT and obesity (BMI > 30 kg/m²)) were significantly associated with 2 year NRM (logistic regression, aHT: p = 0.01, BMI: 0.02) but not with ACM (logistic regression, aHT: p = 0.3, BMI: p = 0.3), suggesting a role of cardiovascular risk factors in mortality of cancer patients, independently of cancer-progression.

In conclusion, longterm overall survival after alloSCT is substantially worse in patients with LVEF ≤ 40%. Arterial hypertension and cardiac hypertrophy adversely affect non-relapse mortality up to two years after transplantation.