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Updated: May 25, 2025
Intramyocardial Cell Delivery: Observations in Murine Hearts
Published on: January 24, 2014
The effect of hematopoietic stem cell transplantation on cardiac mechanics in systemic sclerosis
Chen Chen1, Arvind Nishtala2, Emily Li3
1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Insights
Autologous hematopoietic stem cell transplant (HSCT) significantly improves cardiac mechanics in patients with Systemic sclerosis (SSc). This treatment enhances right ventricular and left atrial function, suggesting a beneficial effect on SSc-related heart disease.
Area of Science:
- Cardiology
- Immunology
- Rheumatology
Background:
- Systemic sclerosis (SSc) is an autoimmune disease characterized by inflammation and fibrosis, often affecting the heart, which can lead to a worse prognosis.
- Cardiac involvement in SSc is frequently subclinical, making early detection and intervention crucial.
- Autologous hematopoietic stem cell transplant (HSCT) is established to improve survival in SSc, but its impact on cardiac function remains unclear.
Purpose of the Study:
- To evaluate the effects of autologous HSCT on cardiac mechanics in patients diagnosed with Systemic sclerosis.
- To assess changes in both right ventricular (RV) and left ventricular (LV) function, as well as left atrial (LA) mechanics, following HSCT.
Main Methods:
- A prospective study identified 88 SSc patients who underwent HSCT between 2009 and 2018.
- Comprehensive echocardiography, including speckle-tracking echocardiography (STE), was performed before and after HSCT.
- Right heart catheterization was conducted pre-HSCT, and clinical variables were compared at baseline and follow-up.
Main Results:
- Significant global improvement in RV strain (18.1% to 20.0%, p<0.01) and RV free wall strain (20.7% to 23.2%, p<0.01) was observed post-HSCT.
- Improvements in RV free wall strain were noted in mid (p=0.04) and apical (p<0.01) segments, but not the basal segment.
- Left atrial reservoir strain significantly improved (35.9% to 47.8%, p<0.01) and LA stiffness decreased (0.24 to 0.18, p<0.01), while LV strain remained unchanged.
Conclusions:
- Autologous HSCT leads to significant improvements in RV and LA mechanics in patients with Systemic sclerosis.
- These findings suggest that HSCT has a favorable impact on the myocardial pathology associated with SSc.
- HSCT may represent a therapeutic strategy to ameliorate cardiac dysfunction in SSc patients.
Abstract:
Systemic sclerosis (SSc) is an autoimmune disease that causes inflammation and fibrosis. Cardiac involvement in SSc is often subclinical and portends a worse prognosis. Autologous hematopoietic stem cell transplant (HSCT) improves survival in SSc but its effect on cardiac function is unknown. This study aimed to assess HSCT's effect on cardiac mechanics in SSc. Participants with SSc who received HSCT at a single academic center between 2009 and 2018 were identified from a prospective registry. All participants underwent comprehensive conventional and speckle-tracking echocardiography (STE) pre- and post-HSCT, and right heart catheterization before HSCT. Baseline and follow-up clinical and echocardiographic variables were compared. Among 88 HSCT recipients (age 51±11 years, 75% female), there was significant improvement of right ventricular (RV) strain globally (18.1±3.9% versus 20.0±4.5%, p < 0.01) and within the RV free wall (20.7±5.3% versus 23.2±5.6%, p < 0.01). Regionally, RV free wall strain improved in the mid (20.4±9.5% versus 23.7±8.0%, p = 0.04) and apical (15.3±8.6% versus 20.9±9.0%, p < 0.01) segments, but not the basal segment. While left ventricular (LV) strain did not change, left atrial (LA) reservoir strain improved (35.9±8.7% versus 47.8±11.4%, p < 0.01) and LA stiffness index (0.24±0.12 versus 0.18±0.08, p < 0.01) decreased post-HSCT. RV and LA mechanics significantly improve after HSCT among patients with SSc. This suggests a favorable effect of HSCT on the underlying myocardial pathology caused by SSc.
