P691Left ventricular systolic function in long term survivors of allogeneic hematopoietic stem cell transplantation

Abstract

Abstract Introduction Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly utilized in young patients. Allo-HSCT usually requires myeloablative therapy that is potentially cardiotoxic. In addition, allo-HSCT survivors have a high prevalence of cardiovascular risk factors. Purpose We aim to describe left ventricular systolic function in long term survivors after allo-HSCT. Methods This study included 104 patients, aged (mean±SD) 18±10 years at allo-HSCT, and follow-up time was 17±6 years. 74% were sufferers of malignant disease. Pre-transplantation therapies consisted of anthracyclines (AnT) in 44% and mediastinal radiotherapy in 2%. Conditioning regimes consisted of cyclophosphamide with bulsulfsan in 77%. 22% received anti-lymphocyte globulin and 6% received total body irradiation. Left ventricular (LV) function was evaluated by 2D and 3D echocardiography. Healthy controls matched for age, sex and BMI were used in group comparisons. Group comparisons were performed by t-tests and chi-square. A linear regression was used to identify contributing factors to reduced systolic LV function in allo-HSCT survivors. Results Most parameters of LV systolic function including 2D and 3D LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral annulus excursion (MAPSE) and s' were all significantly impaired after allo-HSCT as compared to the control group. Significant (p<0.05) contributors to LVEF in the multivariate regression analysis were age, AnT dosage, graft versus host disease (GVHD, occurring in 67%) and hypertension (HT, occurring in 31%). Allo-HSCT Control p value n 104 55 – Gender (female) 56 (54) 29 (53) 0.89 Age (yr) 35±12 36±11 0.44 BMI (kg/m2) 25±5 24±3 0.57 Fractional Shortening (%) 31±6 32±4 0.26 2D LVEF (%) 55±6 59±3 <0.005 3D LVEF (%) 54±5 58±3 <0.005 MAPSE (mm) 13±2 15±2 <0.005 Mean s' (mm) 81±17 89±17 <0.005 2D GLS (%) −17±2 −20±2 <0.005 Values: mean ± SD or n (%), t-test or chi-square. Conclusion LV systolic function is reduced in long term survivors of allo-HSCT. Pre-transplantation AnT, HT and GVHD are significantly associated with increased risk of cardiotoxicity. Acknowledgement/Funding Norwegian Cancer Foundation and Norwegian ExtraFoundation for Health and Rehabilitation