Cardiac function in long-term survivors of children posthematopoietic stem cells transplantation

Abstract

Introduction Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many refractory malignancies, bone marrow failure syndromes, and primary immune deficiencies. Despite the significant improvement in survival after HSCT, the therapy is associated with major short and long-term morbidity and mortality. Cardiovascular complications are increasingly recognized as potential outcomes following HSCT. Echocardiography is the method of choice for detecting myocardial dysfunction before, during, and after chemotherapy. Cardiotoxicity was defined as a decrease in left ventricle ejection fraction (LVEF) more than 10% from the baseline cardiac function or ejection fraction ≤50%. Methods This cross-sectional study was conducted at the pediatric transplantation and cardiology units at Ain Shams University, Cairo, Egypt. Twenty-two long-term survival children underwent hematopoietic stem cells transplantation from 2011 to 2019. Full medical history and examination data were collected. Conventional and two-dimensional (2D) speckle tracking echo were done. Results The mean age of patients at the time of study was 12.95 ± 4.82 years. Mean age at the time of transplant was 7.02 ± 3.84 years. They were 50% males & 50% females. Long-term survival mean duration was six years. About eighty-six percent of the patients had nonmalignant diseases, while 13% patients had malignant diseases. Regarding the conditioning regimen used; 41% received Cy/ATG, 50% received Cy/Bu and 9% received BEAM. Twenty percent of patients developed acute GVHDs (grade I to II), while 22.7% patients developed chronic GVHDs included 13.7% patients limited skin and ocular manifestations, while 9% had extensive chronic GVHDs. Echocardiography showed that all patients had normal systolic and diastolic function. Only one patient (4.5%) had borderline left ventricle dilatation by M mode, while two patients (9%) had abnormal global longitudinal strain (GLS) by 2D speckle tracking. One had a GLS of 16% and the other one had mild hypokinesia with a GLS of 14%. There was no significant difference between studied patients with cardiac affection and those without cardiac affection as regards demographic data, conditioning regimens, GVHDs prophylaxis and complications of transplant (P value > 0.05). Conclusion Monitoring of cardiac function by 2D speckle tracking echo is important to detect any subtle cardiac affection in long-term survivors of HSCT.