Cardiac function after hematopoietic cell transplantation: an echocardiographic cross-sectional study in young adults...

Area of Science:

• Cardiology
• Pediatric Oncology
• Hematology

Background:

• Hematopoietic cell transplantation (HCT) is a vital treatment for malignant disorders.
• Preparative regimens, including chemotherapy and total body irradiation (TBI), can cause cardiovascular side effects.
• Long-term effects of childhood HCT on cardiac function require further investigation.

Purpose of the Study:

• To assess the very long-term cardiac function in patients who underwent childhood HCT.
• To compare cardiac function in HCT survivors with a matched control group.

Main Methods:

• Echocardiography was used to evaluate cardiac function in 18 HCT survivors (median 18 years post-HCT) and 18 controls.
• Measurements included cardiac dimensions, volumes, ejection fraction, diastolic function (E/A ratio), systolic function (fractional shortening, mitral annular plane systolic excursion), right ventricular function (tricuspid annular plane systolic excursion), and NT-proBNP levels.
• Growth hormone (GHmax) and heart rate were also assessed.

Main Results:

• While cardiac dimensions and ejection fractions were normal for body size, HCT survivors exhibited significantly impaired left ventricular diastolic and systolic function.
• Right ventricular function was also significantly reduced in the HCT group.
• Elevated NT-proBNP levels, shorter pulmonary flow acceleration time, higher heart rate, and lower GHmax were observed in HCT survivors, suggesting potential pulmonary involvement and endocrine effects.

Conclusions:

• Childhood HCT with TBI leads to subtle but significant long-term impairments in systolic and diastolic left ventricular function, as well as right ventricular function.
• These cardiac function deficits persist almost two decades after transplantation.
• The findings highlight the need for long-term cardiovascular monitoring in HCT survivors.