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Left Ventricular Systolic Function in Long-Term Survivors of Allogeneic Hematopoietic Stem Cell Transplantation
Richard J Massey1,2, Phoi P Diep2,3,4, Ellen Ruud2,3
1Department of Cardiology, Oslo University Hospital, Oslo, Norway.
Insights
Left ventricular systolic dysfunction is common in long-term survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) treated in youth. Pre-transplant therapies like anthracyclines are associated with reduced cardiac function.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapy increasingly used in younger patients.
- Allo-HSCT survivors face an elevated risk of cardiovascular disease, yet long-term effects on cardiac function remain understudied.
Purpose of the Study:
- To evaluate left ventricular (LV) systolic function in long-term survivors of allo-HSCT who were treated during childhood, adolescence, or early adulthood.
Main Methods:
- A cross-sectional cohort study of 104 allo-HSCT survivors (18 ± 10 years post-transplant) compared to 55 healthy controls.
- Utilized 2D/3D echocardiography and speckle tracking imaging to assess LV systolic function, defining dysfunction by reduced ejection fraction and/or global longitudinal strain.
- Multivariable linear regression identified independent predictors of LV systolic function.
Main Results:
- Allo-HSCT survivors exhibited significantly reduced LV systolic function (2D-LVEF, 3D LVEF, GLS) compared to controls (p < 0.001).
- Left ventricular systolic dysfunction (LVSD) was present in 44.2% of survivors, with 28.3% experiencing symptoms.
- Independent predictors of impaired LV function included age, anthracycline exposure, graft-versus-host disease (GVHD), heart rate, and hypertension. Anthracycline effects were dose-dependent.
Conclusions:
- Left ventricular systolic dysfunction (LVSD) is prevalent in long-term survivors of pediatric and young adult allo-HSCT.
- Factors such as anthracyclines, GVHD, age, heart rate, and hypertension are associated with impaired LV function in these survivors.
Background:
Allogeneic hematopoietic stem cell transplantation (allo-HSCT), a potentially curative therapy for malignant and nonmalignant diseases, is being increasingly used in younger patients. Although allo-HSCT survivors have an established increased risk of cardiovascular disease, there is limited knowledge of the long-term effects on cardiac function in survivors.
Objectives:
The purpose of this study was to describe left ventricular (LV) systolic function in long-term allo-HSCT survivors treated in childhood, adolescence, or early adulthood.
Methods:
Our cross-sectional cohort study included 104 patients (56% women), age 18 ± 10 years at time allo-HSCT with 17 ± 6 years of follow-up. Echocardiography included 2-dimensional (2D) and 3-dimensional (3D) analyses and speckle tracking imaging. In total, 55 healthy control subjects with a similar age, sex, and body mass index were used for comparison. Left ventricular systolic dysfunction (LVSD) was defined as reduced 2D left ventricular ejection fraction (LVEF) of <52% in men and <54% in women, and/or a reduced global longitudinal strain (GLS) of ≥-17%. Multivariable linear regression was used to determine independent predictors of 2D-LVEF and GLS.
Results:
Allo-HSCT survivors had significantly reduced LV systolic function compared with control subjects: 2D-LVEF (55.2 ± 5.8% vs. 59.0 ± 2.9%; p < 0.001), 3D LVEF (54.0 ± 5.1% vs. 57.6 ± 2.7%; p < 0.001), and GLS (-17.5 ± 2.2% vs. -19.8 ± 1.4%; p < 0.001). LVSD was found in 44.2%, of whom 28.3% were symptomatic. Clinical factors independently associated with 2D-LVEF and/or GLS included age, anthracyclines, graft versus host disease (GVHD), heart rate, and hypertension. In the 45% of survivors pre-treated with anthracyclines, the effect of anthracyclines on 2D-LVEF and GLS was dose-dependent.
Conclusions:
LVSD is common in long-term survivors of allo-HSCT treated in their youth. Pre-HSCT therapies with anthracyclines, age, heart rate, hypertension, and graft versus host disease are associated with measures of LV function.
