Alterations in Multiplanar Strain in Bone Marrow Transplant Patients Previously Treated with Anthracyclines

Abstract

Background: Echocardiographic strain analysis can identify subclinical LV dysfunction in patients who have received chemotherapy and bone marrow transplant (BMT). Methods: 50 BMT patients, with previous anthracycline exposure, who underwent a transthoracic echocardiogram (TTE) [Nov 2016–Oct 2017] were compared to 50 age and gender matched controls (departmental database). Standard parameters of LV function (LVEF) and offline strain analysis were performed (GE Echopac). Results: Time from BMT to TTE was 7 ± 6 years. Based on current recommendations [[1]Plana J.C. et al.Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2014; 27: 911-939Abstract Full Text Full Text PDF PubMed Scopus (822) Google Scholar], a normal LVEF cutoff >53% was used. 40 BMT patients had an LVEF > 53%. Global longitudinal strain (GLS) was significantly lower versus controls (18.4 ± 3 vs 20.5 ± 2%; p = 0.001), as was global circumferential strain (GCS) (15.9 ± 4 vs 19.3 ± 4%; p = 0.002). 29 BMT patients and 48 controls had “normal” LV function (LVEF > 53% and GLS > 17). Even in this subgroup, GCS was significantly lower in the BMT group (16.9 ± 4 vs 19.1 ± 4%, p = 0.04) and suggests that it could be an additional marker to detect pre-clinical stage B heart failure. Limitations: This is a single centre cross-sectional study with a limited sample size; lack of serial measurements preclude evaluation of within patient changes over time. Conclusions: Our results provide new insights for the use of multiplanar strain imaging for detection of sub-clinical cardiac dysfunction that may be present in patients after a BMT despite preserved LVEF. Their prognostic value to identify adverse events require further evaluation.