Assessment of Myocardial Function in Children before and after Autologous Peripheral Blood Stem Cell Transplantation
Hala ElMarsafawy1, Mohamed Matter1, Mohamed Sarhan2
1Cardiology Unit, Mansoura University Children Hospital, Mansoura, Egypt.
Insights
Hematopoietic stem cell transplantation (HSCT) in children can cause subtle cardiac dysfunction, affecting both systolic and diastolic functions. Tissue Doppler imaging (TDI) reveals these changes before and after the procedure.
Area of Science:
- Cardiology
- Pediatric Hematology
- Transplantation Medicine
Background:
- Long-term adverse effects of bone marrow transplantation are of increasing concern.
- Subclinical cardiac involvement is frequently observed in adult transplant recipients.
- Limited data exists on cardiac effects in pediatric patients undergoing transplantation.
Purpose of the Study:
- To investigate subclinical cardiac function changes in pediatric patients after autologous hematopoietic stem cell transplantation (HSCT).
- To assess the impact of HSCT conditioning regimens on cardiac function in children.
Main Methods:
- A prospective case-control study involving 19 pediatric patients with normal baseline cardiac function undergoing autologous HSCT.
- Tissue Doppler imaging (TDI) and echocardiographic measurements were performed before and 3 months post-HSCT.
- Standard echocardiographic guidelines from the American Society of Echocardiography were followed.
Main Results:
- Pre-HSCT, significant reductions in mitral annular systolic and diastolic velocities and prolonged isovolumetric relaxation time (IRT) were noted compared to controls.
- Post-HSCT, further reductions in mitral annular velocities and Em/Am ratio, along with prolonged isovolumetric contraction time (ICT) and IRT, were observed.
- Similar abnormalities were detected in the tricuspid annulus, and elevated LV and RV Tei indices persisted after HSCT.
Conclusions:
- TDI effectively detects subtle systolic and diastolic cardiac dysfunction in pediatric HSCT patients.
- The findings suggest that HSCT conditioning regimens adversely affect cardiac function in children.
- Early cardiac monitoring using TDI may be beneficial for pediatric HSCT recipients.
Background:
Increased interest is focused on the long-term adverse effects of bone marrow transplantation. Subclinical cardiac involvement appears common in adults, but only a few reports have examined pediatric patients.
Materials And Methods:
A prospective case-control study of 19 children with normal cardiac function undergoing autologous hematopoietic stem cell transplantation (HSCT) was performed. Tissue Doppler imaging (TDI) and echocardiographic measurements were obtained according to the guidelines of the American Society of Echocardiography before and 3 months after HSCT.
Results:
Lateral mitral annulus before HSCT showed significant reduced mitral systolic annular velocity (P < 0.0001), early diastolic annular velocity (P < 0.0001), late diastolic annular velocity (P = 0.02) and prolonged isovolumetric relaxation time (IRT) (P < 0.0001) compared with control. Significant reduced mitral systolic annular velocity (P < 0.0001), early diastolic annular velocity (P = 0.0005) and Em/Am ratio (P = 0.004), with higher late diastolic annular velocity (P = 0.02) and prolonged isovolumetric contraction time (ICT) (P = 0.003) and IRT (P = 0.002) after HSCT, were observed. Investigation of lateral tricuspid annulus showed nearly similar results as the lateral mitral annulus. LV and RV Tei indices were higher before HSCT compared with control and remained high after HSCT.
Conclusion:
TDI detected subtle abnormalities in systolic and diastolic functions before and after HSCT, which suggests that a conditioning regimen may affect cardiac function.
