Article Text

Download PDFPDF
Original research
The utility of strain imaging in the cardiac surveillance of bone marrow transplant patients
  1. Tejas Deshmukh1,2,
  2. Peter Emerson1,
  3. Paul Geenty1,2,
  4. Shehane Mahendran1,
  5. Luke Stefani1,2,
  6. Megan Hogg3,
  7. Paula Brown1,
  8. Shyam Panicker3,
  9. James Chong1,2,4,
  10. Mikhail Altman1,2,
  11. David Gottlieb2,3,
  12. Liza Thomas1,2,5
  1. 1 Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2 Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Haematology, Westmead Hospital, Sydney, New South Wales, Australia
  4. 4 Centre for Heart Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
  5. 5 South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Professor Liza Thomas, Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia; liza.thomas{at}


Objective To evaluate the utility of two-dimensional multiplanar speckle tracking strain to assess for cardiotoxicity post allogenic bone marrow transplantation (BMT) for haematological conditions.

Methods Cross-sectional study of 120 consecutive patients post-BMT (80 pretreated with anthracyclines (BMT+AC), 40 BMT alone) recruited from a late effects haematology clinic, compared with 80 healthy controls, as part of a long-term cardiotoxicity surveillance study (mean duration from BMT to transthoracic echocardiogram 6±6 years). Left ventricular global longitudinal strain (LV GLS), global circumferential strain (LV GCS) and right ventricular free wall strain (RV FWS) were compared with traditionl parameters of function including LV ejection fraction (LVEF) and RV fractional area change.

Results LV GLS (−17.7±3.0% vs −20.2±1.9%), LV GCS (−14.7±3.5% vs −20.4±2.1%) and RV FWS (−22.6±4.7% vs −28.0±3.8%) were all significantly (p=0.001) reduced in BMT+AC versus controls, while only LV GCS (−15.9±3.5% vs −20.4±2.1%) and RV FWS (−23.9±3.5% vs −28.0±3.8%) were significantly (p=0.001) reduced in BMT group versus controls. Even in patients with LVEF >53%, ~75% of patients in both BMT groups demonstrated a reduction in GCS.

Conclusion Multiplanar strain identifies a greater number of BMT patients with subclinical LV dysfunction rather than by GLS alone, and should be evaluated as part of post-BMT patient surveillence. Reduction in GCS is possibly due to effects of preconditioning, and is not fully explained by AC exposure.

  • heart failure
  • echocardiography

Data availability statement

Data are available on reasonable request to the corresponding author.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request to the corresponding author.

View Full Text


  • Contributors TD, MA, DG and LT: conceived the study. TD, PE, PG, SM, LS, MH, PB, SP, MA and LT: data collection and analysis. TD, PE, PG, MA and LT: analysed and interpreted the data. TD, PE, JC, MA and LT: drafted the initial manuscript. TD, PE, PG, SM, LS, MH, PB, SP, JC, MA, DG and LT: reviewed and edited the manuscript. All authors provided final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.