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Observational Study
. 2021 Dec;8(2):e001768.
doi: 10.1136/openhrt-2021-001768.

Impaired right ventricular function in long-term survivors of allogeneic haematopoietic stem-cell transplantation

Richard John Massey  1   2 , Phoi Phoi Diep  2   3   4 , Marta Maria Burman  2   3   4 , Anette Borger Kvaslerud  5   2 , Lorentz Brinch  4 , Svend Aakhus  6   7 , Lars Gullestad  5   2   8 , Ellen Ruud  2   9 , Jan Otto Beitnes  5
Affiliations
Observational Study

Impaired right ventricular function in long-term survivors of allogeneic haematopoietic stem-cell transplantation

Richard John Massey et al. Open Heart. 2021 Dec.

Abstract

Aims: Survivors of allogeneic haematopoietic stem-cell transplantation (allo-HSCT) are at higher risk of cardiovascular disease. We aimed to describe right ventricular (RV) systolic function and risk factors for RV dysfunction in long-term survivors of allo-HSCT performed in their youth.

Methods and results: This cohort included 103 survivors (53% female), aged (mean±SD) 17.6±9.5 years at allo-HSCT, with a follow-up time of 17.2±5.5 years. Anthracyclines were used as first-line therapy for 44.7% of the survivors. The RV was evaluated with echocardiography, and found survivors to have reduced RV function in comparison to a group of healthy control subjects: Tricuspid annular plane systolic excursion, (TAPSE, 20.8±3.7 mm vs 24.6±3.8 mm, p<0.001), RV peak systolic velocity (RV-s', 11.2±2.3 cm/s vs 12.3±2.3 cm/s, p=0.001), fractional area change (FAC, 41.0±5.2% vs 42.2±5.1%, p=0.047) and RV free-wall strain (RVFWS, -27.1±4.2% vs -28.5±3.3%, p=0.043). RV systolic dysfunction (RVSD) was diagnosed in 14 (13.6%), and was strongly associated with progressive left ventricular systolic dysfunction (LVSD). High dosages of anthracyclines were associated with greater reductions in RV and LV function. Multivariable linear regressions confirmed global longitudinal strain to be a significant independent predictor for reduced RV function.

Conclusion: Impaired RV function was found in long-term survivors of allo-HSCT who were treated in their youth. This was associated with progressive left ventricle dysfunction, and pretransplant therapies with anthracyclines. The occurrence of RVSD was less frequent and was milder than coexisting LVSD in this cohort.

Keywords: echocardiography; heart failure; risk factors.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of study participants. allo-HSCT, allogeneic haematopoietic stem-cell transplantation.
Figure 2
Figure 2
Comparison of right ventricular systolic function between allo-HSCT survivors and healthy controls. Presented with means±SD and adjusted p values. 2D, two dimensions; allo-HSCT, allogeneic haematopoietic stem-cell transplantation; FAC, fractional area change; M-mode, motion-mode ultrasound; RVFWS, Right ventricular Free-Wall Strain (absolute value), RV-s’, right ventricular peak systolic velocity; STE, speckle tracking echocardiography; TAPSE, tricuspid annular plane systolic excursion; TVI, tissue velocity imaging.
See this image and copyright information in PMC

References

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