Cardiac function after hematopoietic cell transplantation: An echocardiographic cross‐sectional study in young adults treated in childhood

Genberg, Margareta; Öberg, Anders; Andrén, Bertil; Hedenström, Hans; Frisk, Per; Flachskampf, Frank A.

doi:10.1002/pbc.25135

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…36 We have previously shown that although several echocardiographic variables were significantly decreased compared with those of healthy control subjects in long-term survivors after HCT, cardiac function was nevertheless comparatively well preserved with all echocardiographic variables within the normal range. 9 It is therefore not surprising that we found no significant associations between W peak , which was clinically significantly decreased, and echocardiographic variables, which were not.…”

Section: Discussionmentioning

confidence: 59%

“…Results from the study have been previously reported. 9,12,17,22 Forty-five children younger than 18 years and 1 patient who was 18.3 years old, with ALL (n = 43) or LBL (n = 3), were treated at Uppsala University Children's Hospital between October 1985 and June 1999 with autologous (n = 31), syngeneic (n = 1), or allogeneic (n = 14) HCT, which included TBI. Of these 46 patients, 29 were alive at the time of inclusion between 2006 and 2009 (autologous/syngeneic, n = 22, allogeneic, n = 7).…”

Section: Patientsmentioning

confidence: 99%

“…In the present study, we used data on pulmonary and cardiac function presented in 2 previous studies that included the same patients and controls. 9,12 Details of the pulmonary function and echocardiography tests were described in detail in these studies. Measurements included in the present study were total lung capacity (TLC), maximum voluntary ventilation, forced expiratory volume in 1 second (FEV 1 ), diffusing capacity of the lung for carbon monoxide (DLco), fractional shortening of the left ventricle (LV-FS), the ratio between the E-wave and the A-wave from the flow profile of mitral valve (E/A), mitral annular plane systolic excursion (MAPSE), and tricuspid annular plane systolic excursion (TAPSE).…”

Section: Assessment Of Pulmonary and Cardiac Functionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] The causes of impaired physical performance include deficits in cardiopulmonary and musculoskeletal function, which may be related to both the primary treatment and the conditioning regimen before HCT. 3,[8][9][10][11][12][13][14][15] Also, growth hormone (GH) deficiency may develop after HCT 16,17 and may impair muscle strength and physical performance. 18 Impaired physical performance may also be caused by, as well as predispose to, physical inactivity.…”

Section: Introductionmentioning

confidence: 99%

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Exercise capacity in young adults after hematopoietic cell transplantation in childhood

Öberg

Genberg

Malinovschi

et al. 2018

American Journal of Transplantation

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A symptom-limited incremental cycle ergometer test was performed in 17 young adult patients treated with hematopoietic cell transplantation and total body irradiation for hematologic malignancies during childhood. These 17 young adult patients were compared with 17 sex- and age-matched healthy control subjects. Assessments of pulmonary function, cardiac function, body composition, and levels of growth hormone were made. The median follow-up was 17.7 years. Patients achieved 63.2% of the predicted peak workload, whereas controls achieved 96.1% (P < .001). All patients, but only 1 control, failed to achieve a peak workload >80% (P < .001). Fat-free mass was significantly lower (43.5 vs 57.6 kg, P < .001) and fat mass percentage was significantly higher (31.8% vs 24.2%, P = .011) in the patients. The peak workload adjusted for fat-free mass was significantly lower in the patients (3.3 vs 4.3, P < .001). In the patients, peak workload correlated significantly with total lung capacity (r = .54, P = .025). In summary, long-term survivors have significantly decreased exercise capacity compared with healthy individuals. Together with their altered body composition, this may predispose them to cardiovascular disease.

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Section: Discussionmentioning

confidence: 59%

Section: Patientsmentioning

confidence: 99%

Section: Assessment Of Pulmonary and Cardiac Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exercise capacity in young adults after hematopoietic cell transplantation in childhood

Öberg

Genberg

Malinovschi

et al. 2018

American Journal of Transplantation

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“…Further, diastolic dysfunction and restrictive cardiomyopathy from pre‐HSCT insults may lead to earlier symptomatic heart failure in those with systolic dysfunction. Long‐term survivors of pediatric HSCT have rates of LVSD between 0 and 26% due in part to nonstandardized monitoring intervals and variable definitions of LVSD . Effects of cardiotoxic therapies may be too subtle to be detected by traditional echocardiography and only become evident (e.g., reduction in ejection fraction) once significant cardiac reserves are depleted .…”

Section: Defining Cardiac Injurymentioning

confidence: 99%

Cardiotoxicity and cardiomyopathy in children and young adult survivors of hematopoietic stem cell transplant

Rotz

Ryan

Hlavaty

et al. 2017

Pediatric Blood & Cancer

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Cardiomyopathy is common in long-term survivors of pediatric hematopoietic stem cell transplant (HSCT). Events occurring before and after HSCT when combined with specific insults during HSCT likely contribute to long-term risk. Strategies for detecting subclinical cardiomyopathy prior to patients developing overt heart failure are under investigation. Changes in HSCT preparative regimens and cardioprotective medications administered during chemotherapy may alter the risk for cardiomyopathy. Interventions in long-term survivors such as lifestyle modification and cardioactive medications are of increasing importance. Herein we review the causes of cardiac injury, discuss strategies for detection of cardiomyopathy, and evaluate therapeutic options for long-term HSCT survivors.

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Evaluation of cardiopulmonary exercise testing, heart function, and quality of life in children after allogenic hematopoietic stem cell transplantation

Vandekerckhove

Waele

Minne

et al. 2018

Pediatric Blood & Cancer

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Background: Physical fitness is an important determinant of quality of life (QOL) after hematopoietic stem cell transplantation. Cardiac function can influence exercise performance. The aim of this study was to assess these factors and their interrelationship. Procedure: Children underwent cardiopulmonary exercise testing (CPET) at least 1 year after hematopoietic stem cell transplantation (HSCT) and were compared with healthy controls. Systolic and diastolic heart function and left ventricle (LV) wall dimensions were measured. Healthrelated QOL (HR-QOL) was evaluated using PedsQL questionnaires.Results: Forty-three patients performed CPET (26 boys, 13.6 ± 3.4 years, weight 45.5 ± 13.3 kg, length 152.9 ± 17.5 cm, body surface area 1.35 ± 0.28). HSCT patients had lower maximal oxygen consumption (VO2peak/kg, 34.7 ± 8.4 vs 46.3 ± 7.1 mL/kg/min, P < 0.001), shorter exercise duration (9.1 ± 2.5 vs 12.9 ± 2.6 min, P < 0.001), and lower maximal load (%Ppeak 70.8 ± 19.7 vs 102.4% ± 15.9%, P < 0.001). Echocardiography demonstrated decreased interventricular septal wall thickness (interventricular septum in diastole [IVSd] Z-value −0.64 ± 0.69, P < 0.001), and more systolic (11% of patients) and diastolic dysfunction (high E/E' Z-value 1.06 ± 1.13, P < 0.001).LV dilatation correlates with VO2max/kg (r = −0.364, P = 0.017). HR-QOL showed lower overall and emotional functioning scores (respectively, P = 0.016 and P = 0.001). Patients after anthracycline therapy have the lowest maximal exercise performance, but have no difference in QOL.Diminished exercise performance is not encountered as a QOL limitation. Total body irradiation influences the domain of psychosocial functioning. Conclusions: LV (systolic and diastolic) and right ventricle dysfunctions justify the need for thorough cardiac follow-up in children after HSCT. Lower physical fitness levels and lower HR-QOL emphasize the importance of CPET and fitness programs. K E Y W O R D S cardiac function, exercise performance, hematopoietic stem cell transplantation, quality of life Abbreviations: CPET, cardiopulmonary exercise testing; GvHD, graft-versus-host disease; EF, ejection fraction; FS, fractional shortening; HR, heart rate; HR-QOL, health-related quality of life; HSCT, hematopoietic stem cell transplantation; LV, left ventricle; LVEDd, left ventricular end diastolic diameter; LVESd, left ventricular end systolic diameter; PedsQL, Pediatric Quality of Life Inventory; QOL, quality of life; RER, respiratory exchange ratio; TAPSE, tricuspid annular plane systolic excursion; TBI, total body irradiation; VAT, ventilatory anaerobic threshold

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Cardiac function after hematopoietic cell transplantation: An echocardiographic cross‐sectional study in young adults treated in childhood

Cited by 11 publications

References 31 publications

Exercise capacity in young adults after hematopoietic cell transplantation in childhood

Exercise capacity in young adults after hematopoietic cell transplantation in childhood

Cardiotoxicity and cardiomyopathy in children and young adult survivors of hematopoietic stem cell transplant

Evaluation of cardiopulmonary exercise testing, heart function, and quality of life in children after allogenic hematopoietic stem cell transplantation

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