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Early Divergent Cardiac Adaptation After Hematopoietic Stem Cell Transplantation: A Multimodal Echocardiographic and
Çetin Alak1, Fazil Çağrı Hunutlu2, Gokhan Ocakoglu3
1Department of Cardiology, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Türkiye.
Insights
Hematopoietic stem cell transplantation (HSCT) causes early, varied cardiac changes, including electrical alterations and specific chamber adaptations. Multiparametric imaging is key to detecting subclinical cardiac responses post-HSCT.
Area of Science:
- Cardiology
- Oncology
- Transplantation Medicine
Background:
- Hematopoietic stem cell transplantation (HSCT) imposes significant cardiovascular stress.
- Subclinical cardiac adaptation post-HSCT remains poorly understood despite risks like inflammation and cardiotoxic therapies.
Purpose of the Study:
- To investigate early electrical and mechanical cardiac responses following HSCT.
- To define subclinical cardiac adaptation using integrated electrocardiographic (ECG) and echocardiographic methods.
Main Methods:
- Prospective cohort study with paired pre-transplant and early post-transplant (3-6 months) ECG and echocardiography.
- Comprehensive echocardiography included tissue Doppler and speckle-tracking for atrial, ventricular, and right heart function.
- Patients were stratified into multiple myeloma (MM) and non-MM subgroups.
Main Results:
- Increased ECG voltage post-HSCT, especially in MM patients, without significant changes in left ventricular (LV) structure or global systolic function.
- Decreased left atrial (LA) reservoir strain observed, alongside selective modulation of diastolic indices.
- Divergent subgroup responses noted: MM patients showed numerical global longitudinal strain (GLS) improvement, while non-MM patients had reduced LV deformation and right ventricular (RV) function.
Conclusions:
- Early cardiac responses after HSCT are heterogeneous and compartment-specific.
- Multiparametric imaging is essential for detecting subclinical cardiac adaptation post-HSCT.
Abstract:
Background/Objectives: Hematopoietic stem cell transplantation (HSCT) exposes patients to cardiovascular stress through inflammation, metabolic disturbances, and prior cardiotoxic therapies. Although overt dysfunction is uncommon early after transplantation, subclinical cardiac adaptation remains poorly defined. Methods: We evaluated early electrical and mechanical cardiac responses after HSCT using integrated electrocardiographic (ECG) and echocardiographic assessment. In this prospective cohort study, patients underwent paired pre-transplant and early post-transplant (3-6 months) ECG and comprehensive echocardiography, including tissue Doppler and speckle-tracking analyses of atrial, ventricular, and right heart function. Results: Patients were stratified into multiple myeloma (MM) and non-MM subgroups. ECG voltage increased after HSCT, particularly in MM patients, without changes in left ventricular (LV) mass, geometry, or global systolic indices, suggesting electrical-structural dissociation. Left atrial (LA) reservoir strain decreased despite stable atrial volumes. Diastolic indices showed selective modulation, including a group-time interaction in the lateral e'/a' ratio without elevated filling pressures. Subgroup analyses suggested divergent myocardial responses, with numerical global longitudinal strain (GLS) improvement in MM patients and reduced LV deformation and right ventricular (RV) fractional area change in non-MM patients. Conclusions: Early cardiac responses after HSCT were heterogeneous and compartment-specific, supporting multiparametric imaging for detection of subclinical cardiac adaptation.
