Question 63: Was an echocardiogram performed?
Indicate if an echocardiogram was performed within 60 days prior to the start of the preparative regimen / infusion.
If an echocardiogram was not performed or it is not known if performed, report No or Unknown, respectively, and continue with question 68.
The Unknown option be selected sparingly and only when no information is available to determine if an echocardiogram was performed at any time prior to the start of the preparative regimen / infusion.
Questions 64 – 66: Was left ventricular ejection fraction (LVEF) or left ventricular shortening fraction reported?
The left ventricular ejection fraction (LVEF) is a percentage that represents the volume of blood pumped from the left ventricle into the aorta (also known as stroke volume) compared to the volume of blood in the ventricle just prior to the heart contraction (also known as end diastolic volume). The left ventricular shortening fraction is the percentage change in cavity dimensions of the left ventricle with systolic contraction.
Report Yes if the LVEF or left ventricular shortening fraction were reported and provide the percentage(s). If the LVEF and left ventricular shortening fraction were assessed, report the results of both. If the LVEF or left ventricular shortening fraction were assessed multiple times, report the most recent value(s).
Report No if both the LVEF and left ventricular shortening fraction were not reported.
Question 67: Is documentation being attached? (CIBMTR recommends attaching the echocardiogram report)
Indicate whether the echocardiogram report is attached to this form. For instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.
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