Changes in Bi-ventricular Function After Hematopoietic Stem Cell Transplant as Assessed by Speckle Tracking Echocardiography

Abstract

Hematopoietic stem cell transplant (HSCT) is a therapeutic option for patients with sickle cell disease (SCD) and severe acquired aplastic anemia (SAA). HSCT may have beneficial effects on ventricular function in damaged myocardium. We hypothesized improvement in ventricular performance and pulmonary hypertension following HSCT with strain echocardiography in SCD and SAA. Echocardiographic strain and other standard functional data were obtained via retrospective cohort analysis of patients (n = 23) with SCD and SAA who underwent HSCT and were followed at a single center between 2000 and 2014. Left ventricular global longitudinal strain was below normal at baseline, and decreased significantly (from - 16.6 to - 11.1, P = 0.05) from pre-HSCT to the initial post-HSCT echocardiogram at 109 (SD ± 83) days. At 351 (SD ± 115) days, longitudinal strain improved significantly from initial decline (from - 11.1 to - 17.5, P = 0.009) but was comparable to baseline (P = 0.43). Other measurements of bi-ventricular function did not change significantly. Tricuspid regurgitation velocities as surrogates for pulmonary hypertension improved in the subset of patients with baseline elevated values although data points were limited. Abnormal myocardial systolic function was detected at baseline with strain imaging. HSCT was associated with initial worsening longitudinal strain values, followed by improvement to baseline levels by 1 year. Insufficient data exist on whether pulmonary hypertension improves after HSCT.

Sickle cell disease and ventricular myocardial strain: A systematic review

“…was retrospective, and one (Mah et al.) was experimental 15,31–43,45,47 . Most studies obtained written consent and approval through an institutional review board or ethics committee.…”

“… 31,33,37,43,45,46 Three studies (Covi et al., Sachdev et al., Sengupta et al.) reported myocardial strain at multiple timepoints, but only values obtained at steady state were included in this systematic review 38,43,44 . In Covi et al.…”

“…In Covi et al. and Sachdev et al., patients were undergoing hematopoietic stem cell transplantation (HSCT); myocardial strain values reported prior to transplantation (presumed steady state) were included 38,43 …”

“…A growing number of studies have evaluated myocardial strain in individuals with SCD, but collective results have not yet been summarized. This systematic review is warranted to synthesize reported findings and remaining gaps in knowledge 15,31–47 …”

Treatment exposures stratify need for echocardiographic screening in asymptomatic long-term survivors of hematopoietic stem cell transplantation

“…In addition, measures of strain can predict future reductions in ejection fraction in adults with breast cancer 12 13 Global longitudinal strain has been used to assess changes in cardiac function over the first-year post-hematopoietic stem cell transplantation in small cohorts of hematopoietic stem cell transplantation patients, 14 though no study of strain has previously been completed among long-term survivors of paediatric hematopoietic stem cell transplantation.…”