Early echocardiographic changes during hematopoietic stem cell transplantation

Patients undergoing hematopoietic stem cell transplantation (HSCT) are exposed to intensive conditioning regimens that may impose substantial cardiac stress during the peri-transplant period; however, early cardiac functional changes during this phase remain poorly characterized, particularly under protective isolation conditions that limit routine imaging. In this prospective observational study, 56 adult HSCT recipients underwent serial bedside transthoracic echocardiography performed before conditioning (pre), on the day of transplantation (t0), 5 days post-transplantation (t5), and at engraftment (eng). Early cardiac functional decline was defined as a ≥ 10% reduction in left ventricular ejection fraction (LVEF) from baseline. LVEF showed a modest but significant transient decline during the early post-transplant period, reaching a nadir at day 5, with partial recovery thereafter. In multivariable analyses, higher baseline cardiac troponin I (cTnI) levels were associated with greater early LVEF decline. An exploratory model incorporating baseline cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and age demonstrated moderate discrimination for early LVEF decline (AUC = 0.741) and a high negative predictive value (90.9%). These findings suggest that early transient cardiac functional alterations may occur during HSCT, and that baseline cTnI may help identify patients at low risk for early functional impairment. Validation in larger cohorts is warranted.