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Early left ventricular dysfunction in children after hematopoietic stem cell transplantation for acute leukemia: a case control study using speckle tracking echocardiography.

Yoon JH, Kim HJ, Lee EJ, Moon S, Lee JY, Lee JW, Chung NG, Cho B, Kim HK - Korean Circ J (2015)

Bottom Line: These data were compared to those of 39 age-matched normal controls.Patients with anthracycline cumulative dose >400 mg/m(2) showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR.It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background and objectives: Cardiovascular complications are the leading cause of morbidity and mortality in childhood cancer survivors. Hematopoietic stem cell transplantation (HSCT) is a curable therapy for pediatric cancer. However, changes in cardiac function in children after HSCT are not well known. We assessed left ventricular (LV) function in children after HSCT using speckle tracking echocardiography (STE).

Subjects and methods: Forty consecutive patients with median age of 11.9 years (range, 1.5-16 years) who received HSCT for acute leukemia and had comprehensive echocardiography before and after (median 9.2 month) HSCT were included in this study. The LV function parameters including conventional tissue Doppler imaging (TDI) and STE data were collected from pre- and post-HSCT echocardiography. These data were compared to those of 39 age-matched normal controls.

Results: Compared to normal controls, post HSCT patients had similar (p=0.06) LV ejection fraction. However, the following three LV function parameters were significantly decreased in post HSCT patients: rate-corrected velocity of circumferential fiber shortening (p=0.04), mitral inflow E velocity (p<0.001), and mitral septal annular E' velocity (p=0.03). The following four STE parameters were also significantly decreased in post HSCT patients: LV global circumferential systolic strain (p<0.01), strain rate (SR, p=0.01), circumferential diastolic SR (p<0.01), and longitudinal diastolic SR (p<0.001). There was no significant change in TDI or STE parameters after HSCT compared to pre-HSCT. Patients with anthracycline cumulative dose >400 mg/m(2) showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR.

Conclusion: Subclinical cardiac dysfunction is evident in children after HSCT. It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens. Serial monitoring of cardiac function is mandatory for all children following HSCT.

No MeSH data available.


Related in: MedlinePlus

Global left ventricular strain (S), strain rate (SR), and diastolic strain rate (DSR) in patients with antracycline cumulative dose <400 mg/m2 (black bar) compared to those in patients with anthracycline cumulative dose >400 mg/m2 (white bar).
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Figure 1: Global left ventricular strain (S), strain rate (SR), and diastolic strain rate (DSR) in patients with antracycline cumulative dose <400 mg/m2 (black bar) compared to those in patients with anthracycline cumulative dose >400 mg/m2 (white bar).

Mentions: The potential effect of age, sex, BMI, oncologic diagnosis, TBI, use of CY, acute GVHD after transplant, and cumulative dose of anthracyclin on cardiac function were analyzed. Eighteen patients who had TBI and CY as conditioning regimens showed slightly decreased global longitudinal diastolic SR (1.70±0.46 sec-1 vs. 1.99±0.55 sec-1, p=0.078) without statistical significance from patients without TBI. LV global longitudinal diastolic SR was significantly decreased in patients who had acute GVHD after HSCT (n=16, 1.67±0.55 sec-1 vs. 1.98±0.48 sec-1, p<0.048). LV global longitudinal diastolic SR showed negative correlations with BMI (r=-0.503, p=0.001) and age at diagnosis (r=-0.612, p<0.001). Sex and diagnosis (AML vs. ALL) were not associated with LV dysfunction. Patients with lifetime cumulative dose of anthracycline more than 400 mg/m2 (n=8) had significantly lower global circumferential systolic strain (-14.7±3.56% vs. -17.3±3.13%, p=0.03) and global circumferential diastolic SR (1.31±0.45 sec-1 vs. 1.80±3.13 sec-1, p=0.015) (Fig. 1).


Early left ventricular dysfunction in children after hematopoietic stem cell transplantation for acute leukemia: a case control study using speckle tracking echocardiography.

Yoon JH, Kim HJ, Lee EJ, Moon S, Lee JY, Lee JW, Chung NG, Cho B, Kim HK - Korean Circ J (2015)

Global left ventricular strain (S), strain rate (SR), and diastolic strain rate (DSR) in patients with antracycline cumulative dose <400 mg/m2 (black bar) compared to those in patients with anthracycline cumulative dose >400 mg/m2 (white bar).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310980&req=5

Figure 1: Global left ventricular strain (S), strain rate (SR), and diastolic strain rate (DSR) in patients with antracycline cumulative dose <400 mg/m2 (black bar) compared to those in patients with anthracycline cumulative dose >400 mg/m2 (white bar).
Mentions: The potential effect of age, sex, BMI, oncologic diagnosis, TBI, use of CY, acute GVHD after transplant, and cumulative dose of anthracyclin on cardiac function were analyzed. Eighteen patients who had TBI and CY as conditioning regimens showed slightly decreased global longitudinal diastolic SR (1.70±0.46 sec-1 vs. 1.99±0.55 sec-1, p=0.078) without statistical significance from patients without TBI. LV global longitudinal diastolic SR was significantly decreased in patients who had acute GVHD after HSCT (n=16, 1.67±0.55 sec-1 vs. 1.98±0.48 sec-1, p<0.048). LV global longitudinal diastolic SR showed negative correlations with BMI (r=-0.503, p=0.001) and age at diagnosis (r=-0.612, p<0.001). Sex and diagnosis (AML vs. ALL) were not associated with LV dysfunction. Patients with lifetime cumulative dose of anthracycline more than 400 mg/m2 (n=8) had significantly lower global circumferential systolic strain (-14.7±3.56% vs. -17.3±3.13%, p=0.03) and global circumferential diastolic SR (1.31±0.45 sec-1 vs. 1.80±3.13 sec-1, p=0.015) (Fig. 1).

Bottom Line: These data were compared to those of 39 age-matched normal controls.Patients with anthracycline cumulative dose >400 mg/m(2) showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR.It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background and objectives: Cardiovascular complications are the leading cause of morbidity and mortality in childhood cancer survivors. Hematopoietic stem cell transplantation (HSCT) is a curable therapy for pediatric cancer. However, changes in cardiac function in children after HSCT are not well known. We assessed left ventricular (LV) function in children after HSCT using speckle tracking echocardiography (STE).

Subjects and methods: Forty consecutive patients with median age of 11.9 years (range, 1.5-16 years) who received HSCT for acute leukemia and had comprehensive echocardiography before and after (median 9.2 month) HSCT were included in this study. The LV function parameters including conventional tissue Doppler imaging (TDI) and STE data were collected from pre- and post-HSCT echocardiography. These data were compared to those of 39 age-matched normal controls.

Results: Compared to normal controls, post HSCT patients had similar (p=0.06) LV ejection fraction. However, the following three LV function parameters were significantly decreased in post HSCT patients: rate-corrected velocity of circumferential fiber shortening (p=0.04), mitral inflow E velocity (p<0.001), and mitral septal annular E' velocity (p=0.03). The following four STE parameters were also significantly decreased in post HSCT patients: LV global circumferential systolic strain (p<0.01), strain rate (SR, p=0.01), circumferential diastolic SR (p<0.01), and longitudinal diastolic SR (p<0.001). There was no significant change in TDI or STE parameters after HSCT compared to pre-HSCT. Patients with anthracycline cumulative dose >400 mg/m(2) showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR.

Conclusion: Subclinical cardiac dysfunction is evident in children after HSCT. It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens. Serial monitoring of cardiac function is mandatory for all children following HSCT.

No MeSH data available.


Related in: MedlinePlus