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Abnormal echocardiography 7 days after stem cell transplantation may be an early indicator of thrombotic
Christopher E Dandoy1, Stella M Davies1, Russel Hirsch2
1Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Routine echocardiography 7 days after hematopoietic stem cell transplantation (HSCT) detects early cardiac issues. This screening may identify vascular injury linked to transplant-associated thrombotic microangiopathy in high-risk patients.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Cardiac complications are a major cause of morbidity and mortality following hematopoietic stem cell transplantation (HSCT).
- Current cardiac evaluation protocols typically rely on clinical indication rather than routine screening in the early post-transplant period.
- The benefit of early, routine cardiac screening in pediatric and young adult HSCT recipients, a population susceptible to tissue injury, remains unexamined.
Purpose of the Study:
- To prospectively evaluate the utility of scheduled echocardiographic screening for early cardiac complications in pediatric and young adult HSCT patients.
- To determine the incidence of cardiac abnormalities detected by routine screening on day +7 post-HSCT.
- To investigate the association between early echocardiographic findings and clinical outcomes, including survival and transplant-associated thrombotic microangiopathy (TA-TMA).
Main Methods:
- A single-center prospective clinical study involving 100 consecutive HSCT patients.
- All patients underwent scheduled echocardiographic screening on day +7 post-transplantation, irrespective of clinical status.
- Echocardiographic parameters assessed included pericardial effusion, right ventricular pressure, and left ventricular function.
Main Results:
- At least one cardiac abnormality was detected in 30% of patients on day +7 post-HSCT.
- Specific findings included pericardial effusion (17%), elevated right ventricular pressure (13%), and reduced left ventricular function (3%).
- Patients with any day +7 echocardiographic abnormality showed a trend towards reduced survival (67% vs. 80%, P = .073). Elevated right ventricular pressure was significantly associated with TA-TMA (P = .004), suggesting early vascular injury.
Conclusions:
- Scheduled echocardiography on day +7 after HSCT is effective in detecting early cardiac complications.
- This screening approach may identify patients at risk for adverse outcomes, including vascular injury associated with TA-TMA.
- Routine early cardiac screening could improve risk stratification and management of HSCT recipients.
Abstract:
Cardiac complications after hematopoietic stem cell transplantation (HSCT) can lead to significant morbidity and mortality. Cardiac evaluation during the first 100 days after HSCT is usually performed only if clinically indicated, and no studies have examined whether routine screening is beneficial in this patient population at high risk for tissue injury. We conducted a single-center prospective clinical study to screen for cardiac complications in pediatric and young adult patients. One hundred consecutive HSCT patients underwent scheduled echocardiographic screening on day +7 after transplantation, independent of their clinical condition. At least 1 abnormality was identified in 30% of cases. Seventeen children had a pericardial effusion, 13 elevated right ventricular pressure, and 3 reduced left ventricular function. Survival was reduced in children with any echocardiographic abnormality at day 7 (67% versus 80% in those with and without, respectively, abnormality, P = .073). Moreover, raised right ventricular pressure at day +7 was significantly associated with transplant-associated thrombotic microangiopathy (TA-TMA; P = .004) and may indicate early vascular injury in the lungs. These data suggest that echocardiography 7 days after HSCT can detect early cardiac complications of HSCT and may identify early vascular injury associated with TA-TMA.
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