Abstract 13093: Global Longitudinal Strain Prediction of Cardiac Dysfunction in Hematopoietic Stem Cell Transplant Patients

Abstract

Introduction and Hypothesis: Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for hematological malignancies, but patients undergoing HSCT are at increased risk of cardiovascular events and death. Global longitudinal strain (GLS) is more sensitive than left ventricular ejection fraction (LVEF) to identify subclinical LV dysfunction. Early heart failure guideline-directed medical therapy (GDMT) may improve heart function and symptoms in these patients. Methods: Transthoracic echocardiography with speckle tracking was performed every 3 months for 9 months before and after BMT (Figure 1A), with GLS and LVEF as markers of systolic function and E/e' as markers of diastolic function, troponin I, NT-ProBNP and D-dimer as markers of cardiac insufficiency. Patients with a 10% reduction in GLS or a 15% reduction in LVEF from baseline were defined as LV dysfunction and GDMT were prescribed. Results: A total of 27acute myeloid leukemia and 5 acute lymphoblastic leukemia received high dose cyclophosphamide before HSCT, 2 patients developed minimal pericardial effusion without tamponade, 2 patients expired during transplantation. The mean GLS before HSCT was -16.8±0.75%, which was significantly reduced to -15.11±0.86% (p=0.026) after 3 months (Figure 1B). After GDMT, GLS improved to -18.86±1.6% 9 months after HSCT. No significant changes in LVEF, E/e' and serum biomarkers during follow-up Conclusions: Our results further support an increased risk of subclinical myocardial dysfunction in patients with hematological malignancies on HSCT. In these patients, GLS may be an earlier noninvasive marker than LVEF, ECG, or serum biomarkers. Early heart failure GDMT may improve heart function once GLS is reduced.