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The serial changes in myocardial functions after paediatric haematopoietic stem cell transplantation
Zehra Diyar Tamburacı Uslu1, Filiz Ekici2, Koray Yalçın3
1Pediatric Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.
Insights
Hematopoietic stem cell transplantation impacts children's heart function, particularly the right ventricle, for up to a year. Monitoring myocardial function post-transplant is crucial.
Area of Science:
- Pediatric Cardiology
- Hematology
- Oncology
Background:
- Chemotherapy and hematopoietic stem cell transplantation (HSCT) can affect myocardial function in children.
- Long-term cardiac effects of HSCT in pediatric non-malignant diseases require further investigation.
Purpose of the Study:
- To assess changes in myocardial function in children post-HSCT.
- To determine the impact of baseline echocardiographic parameters on mortality.
Main Methods:
- Conventional and tissue Doppler echocardiography used in 39 pediatric patients and 39 controls.
- Cardiac function assessed pre-HSCT and at 1, 3, 6, and 12 months post-HSCT.
Main Results:
- Subclinical impairment in both left and right ventricular function observed post-HSCT.
- Right ventricular dysfunction persisted longer (up to 1 year) than left ventricular dysfunction.
- Lower baseline septal E' velocity predicted mortality.
Conclusions:
- HSCT can lead to subclinical biventricular dysfunction in children.
- Right ventricular function recovery is prolonged post-HSCT.
- Continued monitoring of myocardial function beyond one year is recommended.
Abstract:
The aim of this study is to evaluate the changes in myocardial functions in children who underwent haematopoietic stem cell transplantation along with associated chemotherapy. Additionally, we evaluated the effect of baseline echocardiographic parameters on mortality. We evaluated 39 patients (mean age 7.4 years) who underwent haematopoietic stem cell transplantation owing to non-malignant disease. The control group included 39 healthy children who had normal cardiac findings. The myocardial functions were evaluated in all subjects by conventional echocardiography and tissue Doppler echocardiography before haematopoietic stem cell transplantation and in the 1st, 3rd, 6th, and 12th month after haematopoietic stem cell transplantation. All patients had normal left ventricular ejection fraction before haematopoietic stem cell transplantation, except one case. Before haematopoietic stem cell transplantation, the patient group had significantly greater mean pulmonary artery pressure and lower tricuspid valve annular plane excursion rate. Baseline E' velocities for mitral lateral annuli, septum, and tricuspid lateral annuli were lower in the patient group than the control group. The E' velocities for the left ventricle decreased in the patient group after haematopoietic stem cell transplantation, and then returned to baseline levels at the 6 months. E' and S' velocities for tricuspid lateral annuli also decreased after haematopoietic stem cell transplantation and were still depressed in the first year after haematopoietic stem cell transplantation. Baseline E' velocity for septum was significantly lower in patients who died after haematopoietic stem cell transplantation than patients who survived (p = 0.009). Subclinical impairment in both ventricular functions was observed after haematopoietic stem cell transplantation and the right ventricular functions were affected for longer periods than left ventricle after haematopoietic stem cell transplantation. The myocardial functions should be monitored after the first year of haematopoietic stem cell transplantation.
