Changes in echocardiographic measures of systolic and diastolic function in children 1 year after hematopoietic SCT

Hematopoietic SCT (HSCT) is a life-saving therapy in children, but has been associated with heart failure. Little is known about subclinical changes in cardiac function. We examined changes in systolic and diastolic function from pre- to 1-year post HSCT by echocardiography. All patients (n = 74, 61% men, median age 9.1 years, mean left-ventricular (LV) ejection fraction 61.3 +/- 4.9%) who underwent HSCT at Children's Hospital Boston between 2005 and 2008, were <21 years at time of HSCT, and had routine pre- and 1-year post echocardiograms were included. Systolic function parameters, including LV ejection fraction, rate-corrected velocity of fiber shortening (Vcfc) and stress-velocity index and diastolic parameters, including tissue Doppler imaging (TDI)-derived velocities, and left-ventricular flow propagation, were compared before and after transplant. At 1-year post HSCT, systolic function, as measured by Vcfc (1.10 +/- 0.15 vs 1.04 +/- 0.12 circ/s; P = 0.03) and stress-velocity index (z-score 0.40 +/- 1.4 vs -0.20 +/- 1.1; P = 0.02), had worsened; diastolic function parameters, including mitral E' velocity (16.6 +/- 3.9 vs 15.0 +/- 3.4 cm/s; P - 0.01) and tricuspid E' velocity (14.3 +/- 3.6 vs 12.4 +/- 2.8 cm/s; P = 0.002) had also decreased. At 1-year post HSCT, children have subclinical declines in systolic and diastolic function. These small changes might become clinically important over time. Serial non-invasive assessment of cardiac function should be considered in all children following HSCT. Bone Marrow Transplantation (2011) 46, 1532-1539; doi:10.1038/bmt.2010.345; published online 31 January 2011