Author + information
- Richard J. Massey, MSca,b,∗ ( )(, )@masseyrichardh1,
- Phoi P. Diep, MDb,c,d,
- Ellen Ruud, MD, PhDb,c,
- Marta M. Burman, MDb,c,d,
- Anette B. Kvaslerud, MDa,b,
- Lorentz Brinch, MD, PhDe,
- Svend Aakhus, MD, PhDf,g,
- Lars L. Gullestad, MD, PhDa,b,h and
- Jan O. Beitnes, MD, PhDa
- aDepartment of Cardiology, Oslo University Hospital, Oslo, Norway
- bDepartment of Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- cDepartment of Hematology and Oncology, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- dDepartment of Pediatric Research, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- eDepartment of Hematology, Oslo University Hospital, Oslo, Norway
- fDepartment of Circulation and Imaging, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- gClinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
- hKG Jebsen Center for Cardiac Research, University of Oslo, and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- ↵∗Address for correspondence:
Mr. Richard J. Massey, Cardiology Department, Oslo University Hospital, Rikshopitalet, Sognsvannsveien 20, 0372 Oslo, Norway.
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.
- cardiovascular risk factors
- graft versus host disease
- heart failure
- left ventricular systolic function
This study is funded by the Norwegian Extra-foundation and the Norwegian Cancer foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: CardioOncology author instructions page.
- Received January 28, 2020.
- Revision received June 28, 2020.
- Accepted June 29, 2020.
- 2020 The Authors