Effects of Hematopoietic Stem Cell Transplantation on Cardiac Function

Background: The acute effects of chemotherapy on cardiac function have been researched, but the effects of hematopoietic stem cell transplantation (HSCT), on cardiac function are studied less frequently.

Objective: We aimed to evaluate serial cardiac functional changes during on year, from pre- to 1-year post-HSCT by echocardiography in pediatric acute myeloid leukemia (AML) patients.

Methods: From July 2009 to December 2014, 49 (33 males, 16 females) AML patients underwent HSCT at The Catholic University of Korea, Seoul St. Mary’s Hospital, survived up till 1-year post-HSCT, and had completed echocardiographic studies according to our institutional protocol. Median (range) age at diagnosis and HSCT were 7.9 (1.1-16.0) years and 9.1 (1.5-16.5) years, respectively. Median (range) cumulative Anthracycline dosage administered prior to HSCT was 318 mg/m² (135-604 mg/m²). None had radiation therapy before HSCT. Echocardiographic systolic and diastolic functional parameters, especially using tissue Doppler imaging (TDI), within 1 month before, 6-month and 1-year after HSCT were analyzed.

Results: Left ventricular ejection fraction, shortening fraction, mass and end-diastolic wall thickness did not change significantly after HSCT, but left ventricular end-diastolic dimension decreased significantly after HSCT. Mitral inflow Doppler indices did not change after HSCT. TDI S’ velocity showed transient, but significant decreased at 6 month in mitral septal annulus. Mitral septal and lateral annulus TDI E’ velocity decreased significantly at 6 month and 1 year after HSCT, but tricuspid TDI E’ velocity did not change significantly. TDI myocardial performance index in the mitral septal and tricuspid lateral annulus increased at 6 month and 1 year after HSCT, and mitral lateral annulus TDI myocardial performance index showed transient increase at 6 months after HSCT.

Conclusion: This study showed that significant changes, although subclinical, in left ventricular systolic and diastolic functions occur after hematopoietic stem cell transplantation in pediatric acute myeloid leukemia patients. Close follow-up study is mandatory in this population to elucidate the long term effects of hematopoietic stem cell transplantation on cardiac functions.