Left ventricular dysfunction in patients following high-dose chemotherapy and autologous hematopoietic stem cell transplantation

Aim. To evaluate the dynamics of LV global longitudinal strain (GLS) and other EchoCG parameters after high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell transplantation (aHSCT).

Material and methods. The risk of LV dysfunction in patients after HDCT followed by aHSCT has not been sufficiently studied. This study included 74 patients with hemoblastosis aged 20 to 65 years who had undergone HDCT followed by aHSCT. All patients had a history of antitumor treatment. EchoCG with assessment of LV GLS and measurements of troponin T and N-terminal pro-brain natriuretic peptide (NT-proBNP) were performed for all patients before and after the treatment.

Results. A decrease in GLS by 15 % or more from the baseline was detected in 6 (8.1 %) patients. The decrease in GLS was associated with increased NT-proBNP >125 pg / ml at baseline (odds ratio, 8.667; 95 % confidence interval, 1.419-52.942; p=0.022).

Conclusion. The decrease in LV GLS in patients after aHSCT was associated with increased NT-proBNP before the intervention.

1. Passweg JR, Baldomero H, Chabannon C, Basak GW, de la Cámara R, Corbacioglu S et al. Hematopoietic cell transplantation and cellular therapy survey of the EBMT: monitoring of activities and trends over 30 years. Bone Marrow Transplantation. 2021;56(7):1651–64. DOI: 10.1038/s41409-021-01227-8

2. Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D et al. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. European Heart Journal. 2022;43(4):280–99. DOI: 10.1093/eurheartj/ ehab674

3. Armenian SH, Ryan TD, Khouri MG. Cardiac Dysfunction and Heart Failure in Hematopoietic Cell Transplantation Survivors. Heart Failure Clinics. 2017;13(2):337–45. DOI: 10.1016/j.hfc.2016.12.008

4. Tuzovic M, Mead M, Young PA, Schiller G, Yang EH. Cardiac Complications in the Adult Bone Marrow Transplant Patient. Current Oncology Reports. 2019;21(3):28. DOI: 10.1007/s11912-019-0774-6

5. Duléry R, Mohty R, Labopin M, Sestili S, Malard F, Brissot E et al. Early Cardiac Toxicity Associated With Post-Transplant Cyclophosphamide in Allogeneic Stem Cell Transplantation. JACC: CardioOncology. 2021;3(2):250–9. DOI: 10.1016/j.jaccao.2021.02.011

6. Oliveira GH, Al-Kindi SG, Guha A, Dey AK, Rhea IB, deLima MJ. Cardiovascular risk assessment and management of patients undergoing hematopoietic cell transplantation. Bone Marrow Transplantation. 2021;56(3):544–51. DOI: 10.1038/s41409-020-01080-1

7. Alblooshi R, Kanfar S, Lord B, Atenafu EG, Michelis FV, Pasic I et al. Clinical prevalence and outcome of cardiovascular events in the first 100 days postallogeneic hematopoietic stem cell transplant. European Journal of Haematology. 2021;106(1):32–9. DOI: 10.1111/ejh.13482

8. Nabiałek-Trojanowska I, Lewicka E, Wrona A, Kaleta AM, Lewicka-Potocka Z, Raczak G et al. Cardiovascular complications after radiotherapy. Cardiology Journal. 2020;27(6):836–47. DOI: 10.5603/CJ.a2018.0120

9. Vasyuk Yu.A., Gendlin G.E., Emelina E.I., Shupenina E.Yu., Ballyuzek M.F., Barinova I.V. et al. Сonsensus statement of Russian experts on the prevention, diagnosis and treatment of cardiotoxicity of anticancer therapy. Russian Journal of Cardiology. 2021;26(9):152–233. DOI: 10.15829/1560-4071-2021-4703

10. Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). European Heart Journal - Cardiovascular Imaging. 2022;23(10):e333–465. DOI: 10.1093/ehjci/jeac106

11. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100(21):1673–80. DOI: 10.1136/heartjnl-2014-305538

12. ElMarsafawy H, Matter M, Sarhan M, El-Ashry R, Al-Tonbary Y. Assessment of Myocardial Function in Children before and after Autologous Peripheral Blood Stem Cell Transplantation. Echocardiography. 2016;33(1):82–9. DOI: 10.1111/echo.12988

13. Čelutkienė J, Pudil R, López‐Fernández T, Grapsa J, Nihoyannopoulos P, Bergler‐Klein J et al. Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC). European Journal of Heart Failure. 2020;22(9):1504–24. DOI: 10.1002/ejhf.1957

14. Oikonomou EK, Kokkinidis DG, Kampaktsis PN, Amir EA, Marwick TH, Gupta D et al. Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis. JAMA Cardiology. 2019;4(10):1007–18. DOI: 10.1001/jamacardio.2019.2952

15. Emelina E.I., Gendlin G.E., Nikitin I.G. Cardiooncology and Oncohematology: Examination Algorithms, Prophylactic and Treatment of Cardiotoxicity, Trends in Rehabilitation. Clinical oncohematology. 2021;14(2):239–61. DOI: 10.21320/2500-2139-2021-14-2-239-261