Abstract
High-dose chemotherapy (HDC) followed by stem cell transplantation (HSCT) is a well-established method in patients with hematological malignancies, and for last few years, many efforts have been made to estimate short- and long-term efficacy of this method, as well as early and late complications. The present study concentrates on cardiotoxic effects, mainly early changes using biochemical markers such as N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn). Simultaneously, the analysis of 12-lead ECG was done before and after the procedure in which the novel repolarization markers: Tp–e and Tp–e/QT ratio were measured, together with standard markers: QT, QTc. It was found that NT-pro BNP was significantly increased after HSCT in comparison to results before it, and no significant changes were present in Troponin levels. Simultaneously, Tp–e interval and Tp–e/QT ratio were significantly higher after HSCT. The use of cyclophosphamide, advanced age, and higher level of blood cholesterol concentration were risk factors for the increase in NT-proBNP and treatment with cyclophosphamide as well as fludarabine and higher creatinine levels were risk factors for the increase in Tp–e/QT ratio. In conclusion, in the early term evaluation after HSCT in patients with no previously diagnosed heart disease, the mild changes in markers of heart overload and repolarization were noted. The observations suggest that in all patients undergoing HSCT, even the ones without pre-existing cardiovascular disease, the evaluation, and monitoring of heart function should be considered.
Highlights
The problem of cardiotoxicity of chemotherapy has been known for last decades
In all patients enrolled in the study, cardiac biomarkers were measured in blood, that is NT-proBNP and TnT (Troponin) as well as 12-lead electrocardiography (ECG) was performed; all tests we done twice
In electrocardiographic parameters of repolarization, no differences were found in QTc before and after the transplantation, but Tp–e interval and Tp–e/QT ratio were significantly higher after hematopoietic stem cell transplantation (HSCT) than
Summary
The influence of the peripheral blood stem cell transplantation with prior high dose chemotherapy is still under study. A procedure of high-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (HSCT) is used to treat numerous diseases. One of the proposed markers to evaluate early cardiotoxic effects are troponin and natriuretic peptides, that is mainly B-type natriuretic peptide (BNP). NT-pro-BNP is secreted by myocardial cells in response to increased pressure and volume and is used to identify left ventricular dysfunction; there are more data on supporting the role in predicting future cardiac events especially in coronary artery disease, and new data are being gathered as for the screening tool for left ventricular dysfunction in different populations [2,3,4,5]
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