Subacute cardiac toxicity following autologous haemopoietic stem-cell transplantation in patients with normal cardiac function

Tommy Chung ¹, Wee-Ching Lim ², Raymond Sy ³, Ilona Cunningham ², Judith Trotman ² and Leonard Kritharides ^3*

¹ Concord Hospital, Australia
² Department of Haematology, Concord Hospital, Australia
³ Department of Cardiology, Concord Hospital, Australia

^* To whom correspondence should be addressed. E-mail: l.kritharides{at}unsw.edu.au.

Accepted 13 November 2007

Abstract

Objective We have investigated subacute cardiac toxicity in patients with normal baseline cardiac function following autologous haemopoietic stem-cell transplantation.

Design Prospective observational study.

Patient and Methods Thirty-two consecutive patients (aged 60+/-11 years) with normal left ventricular ejection fraction (LVEF >=50%) undergoing autologous haemopoietic stem-cell transplantation were studied. Transthoracic echocardiography (including colour tissue-Doppler imaging-derived myocardial velocities, strain and strain rates), troponin-T and B-type natriuretic peptide (BNP), and clinical details were recorded at baseline, following conditioning chemotherapy, and serially over 6 weeks from the day of transplantation.

Results The LVEF at baseline was 62+/-6% (mean+/-SD) and decreased to 55+/-16%, 6 weeks after transplantation (p=0.007). Cardiac toxicity (>10% absolute decline of LVEF to a LVEF <50%) developed in 10 (31%) patients within 17+/-8 days of transplantation and was usually reversible. In these 10 patients, the nadir LVEF was 39+/-12%. Two patients developed severe clinical pulmonary oedema, one episode of which was fatal. Troponin-T was mildly elevated in only three of the patients with cardiac toxicity. Peak BNP values were similar in patients with or without post-transplant cardiac toxicity (149+/-100 versus 196+/-178pg/ml, p=0.43). Multivariate Cox proportional hazard regression identified baseline mitral-annular systolic velocity as the only independent predictor of cardiac toxicity (hazard ratio 0.42, 95% confidence interval 0.20-0.86, p=0.02).

Conclusion Subacute cardiac toxicity is common after autologous haematopoietic stem-cell transplantation, even in patients with apparently normal left ventricular function. Anticipation of the period of greatest risk and recognition of patients with subclinical myocardial dysfunction may prevent clinical heart failure.

Keywords: Tissue Doppler Imaging, cardiac toxicity, echocardiography, high-dose chemotherapy

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