Reduced exercise capacity is associated with left ventricular systolic dysfunction in long‐term survivors of allogeneic hematopoietic stem‐cell transplantation

Abstract

Purpose Exercise intolerance is a common complication in survivors of allogeneic hematopoietic stem‐cell transplantation (allo‐HSCT). The aim of this study was to determine if cardiac function measured with echocardiography is associated with exercise capacity measured with cardio‐pulmonary exercise tests in long‐term survivors treated in their youth with allo‐HSCT. Methods The study included 96 patients, of which 54.2% were female, aged 34.9 ± 11.6 years and 17.7 ± 9.3 years after allo‐HSCT. Reduced exercise capacity was defined as <85% of predicted‐peak oxygen uptake (VO2peak). Linear regression was used in the prediction of VO2peak (ml/kg/min). Receiver operating characteristic evaluated the accuracy of predicting reduced exercise capacity. Results VO2peak was 36.2 ± 7.7 ml/kg/min and 43 (44.8%) had reduced exercise capacity. Left ventricular ejection fraction was 55.4 ± 5.9% and global longitudinal strain (GLS) was −17.6% ± 2.0%. Left and right ventricular functions were significantly lower in survivors with reduced exercise capacity. Increased body mass index, lower physical activity score, reduced pulmonary function (by forced expiratory volume in 1‐s) and reduced left ventricular systolic function (by GLS) were significant independent predictors for reduced VO2peak. GLS was superior to other echocardiographical indices for identifying reduced exercise capacity (area under curve = 0.64, p = 0.014). Conclusions Left ventricular systolic dysfunction measured by GLS is associated with reduced exercise capacity in long‐term allo‐HSCT survivors.

In search for the optimal ventricular systolic dysfunction metric that associates with reduced exercise capacity

“…Massey et al 2 did not report on ESV and EDV, and thus neglected the primary variables which have been shown to also add incremental value to GLS, as documented in the literature 14 and illustrated in Figure 1A by including EFC (with EDV as a surrogate). It may be relevant to reanalyze their precious data set against this background, and also consider sex‐specific aspects 12 …”

“…In a carefully carried out study, Massey et al analyzed the association between LV systolic dysfunction and reduced exercise capacity in 96 (54% female) allogeneic hematopoietic stem-cell transplantation (allo-HSCT) survivors, of whom 74% had a treated malignancy. 2 The investigations concern adolescents and young adults, and refer to data reported at follow-up, collected on average some 17 years after allo-HSCT. Their study is complementary to earlier publications on these patients and specifically aims to describe in detail cardiac function by ultrasound assessment beyond 2D-LVEF.…”

“…Recently it was observed that a supranormal value for EF rather than being extremely good, in contrast implies incremental risk, as opposed to the earlier accepted paradigm. 16 Massey et al 2 did not report on ESV and EDV, and thus neglected the primary variables which have been shown to also add incremental value to GLS, as documented in the literature 14 and illustrated in Figure 1A by including EFC (with EDV as a surrogate). It may be relevant to reanalyze their precious data set against this background, and also consider sex-specific aspects.…”