Left Ventricular Systolic Function in Long-Term Survivors of Allogeneic Hematopoietic Stem Cell Transplantation

Richard J. Massey, MSc; Phoi P. Diep, MD; Ellen Ruud, MD, PhD; Marta M. Burman, MD; Anette B. Kvaslerud, MD; Lorentz Brinch, MD, PhD; Svend Aakhus, MD, PhD; Lars L. Gullestad, MD, PhD; Jan O. Beitnes, MD, PhD

JACC. CardioOncology (Sep 2020)

Left Ventricular Systolic Function in Long-Term Survivors of Allogeneic Hematopoietic Stem Cell Transplantation

Richard J. Massey, MSc,
Phoi P. Diep, MD,
Ellen Ruud, MD, PhD,
Marta M. Burman, MD,
Anette B. Kvaslerud, MD,
Lorentz Brinch, MD, PhD,
Svend Aakhus, MD, PhD,
Lars L. Gullestad, MD, PhD,
Jan O. Beitnes, MD, PhD

Affiliations

Richard J. Massey, MSc: Department of Cardiology, Oslo University Hospital, Oslo, Norway; Department of Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Address for correspondence: Mr. Richard J. Massey, Cardiology Department, Oslo University Hospital, Rikshopitalet, Sognsvannsveien 20, 0372 Oslo, Norway.
Phoi P. Diep, MD: Department of Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hematology and Oncology, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Department of Pediatric Research, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Ellen Ruud, MD, PhD: Department of Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hematology and Oncology, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Marta M. Burman, MD: Department of Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hematology and Oncology, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Department of Pediatric Research, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Anette B. Kvaslerud, MD: Department of Cardiology, Oslo University Hospital, Oslo, Norway; Department of Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
Lorentz Brinch, MD, PhD: Department of Hematology, Oslo University Hospital, Oslo, Norway
Svend Aakhus, MD, PhD: Department of Circulation and Imaging, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
Lars L. Gullestad, MD, PhD: Department of Cardiology, Oslo University Hospital, Oslo, Norway; Department of Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; KG Jebsen Center for Cardiac Research, University of Oslo, and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
Jan O. Beitnes, MD, PhD: Department of Cardiology, Oslo University Hospital, Oslo, Norway

Journal volume & issue: Vol. 2, no. 3
pp. 460 – 471

Abstract

Read online

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.

Published in JACC. CardioOncology

ISSN: 2666-0873 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jacc-cardiooncology

About the journal

Abstract

Keywords