Abstract 16432: Screening for Cardiovascular Complications in Pediatric Hematopoietic Stem Cell Transplant Patients

Abstract

Introduction: Hematopoietic stem cell transplantation (HSCT) carries a risk of cardiovascular morbidity, with reported incidences of pericardial effusion, pulmonary hypertension (PH), and reduced left ventricular ejection fraction (LVEF). Screening for cardiovascular complications in children undergoing HSCT may be essential, but its utility remains unexplored. Hypothesis: Screening HSCT children using echocardiography and brain natriuretic peptide (BNP) can detect cardiovascular complications associated with adverse outcomes in this population. Methods: This prospective single-center cohort study analyzed children undergoing HSCT over a 2-year period. Baseline, 7-day, and 30-day echocardiograms and BNP levels were obtained. Multilevel linear regression assessed changes in echocardiograms and BNP. Logistic regression determined associations between cardiac complications and outcomes. Results: The study included 43 patients, with a median age of 8.6 years (IQR 3.7, 14.6). Echocardiograms were obtained at baseline (n=43), day+7 (n=34), and day+30 (n=25). BNP levels were obtained at baseline (n=41), day+7 (n=34), and day+30 (n=12). Adverse outcomes included TMA (n=7), endothelial dysfunction (n=36), mechanical ventilation (n=8), and death (n=8). Pericardial effusion was the most common finding (n=2(6%) at day+7, n=4(16%) at day+30). Pericardial effusion at either day+7 or day+30 predicted death (OR 15.7, 95% CI 1.8-137, p=0.013) and TMA (OR 13.1, 95% CI 1.7-103, p=0.014). A 10% decrease in LVEF was observed in 6 (17%) of patients at day+7 and 2 (8%) at day+30, and was associated with reduced mortality (OR 0.1, 95% CI 0-0.6, p=0.009). The change in BNP level at day+7 was 7pg/mL (IQR 6, 66) and 5pg/mL (IQR 3, 20) at day+30. A 10 point increase in BNP carried an increased risk of endothelial dysfunction (OR 4.1, 95% CI 1.3-263, p<0.001). No patients developed PH. Conclusions: Cardiovascular complications are common after HSCT in children and carry diagnostic and prognostic significance. Further refinement of the screening protocol is necessary to determine the optimal timing of testing and assess its clinical utility.