Cardiovascular function in long-term hematopoietic cell transplantation survivors Journal Article


Authors: Armenian, S. H.; Horak, D.; Scott, J. M.; Mills, G.; Siyahian, A.; Berano Teh, J.; Douglas, P. S.; Forman, S. J.; Bhatia, S.; Jones, L. W.
Article Title: Cardiovascular function in long-term hematopoietic cell transplantation survivors
Abstract: Peak oxygen consumption (VO2peak), as measured by cardiopulmonary exercise testing (CPET), is a powerful independent predictor of cardiovascular disease (CVD) and all-cause mortality in a broad range of populations. We assessed the safety and feasibility of CPET in aging long-term hematopoietic cell transplantation (HCT) survivors, a population at high risk for premature onset of CVD. Next, we examined how organ-specific impairments (eg, cardiac, pulmonary, hematologic) impact VO2peak after HCT. Twenty consecutive HCT survivors underwent a comprehensive assessment of cardiopulmonary health that included CPET, echocardiography with strain, pulmonary function testing, 6-minute walk test, and timed up and go. Median age at assessment was 67.4 years (range, 42 to 75), and median time from HCT was 9.8 years (range, 3 to 20). No adverse events were observed during CPET procedures, and 95% of studies were considered to be at “peak” effort (respiratory exchange ratio ≥ 1.10). VO2peak was on average 22% less than predicted, and allogeneic HCT survivors had markedly lower VO2peak when compared with autologous HCT survivors (18.2 mL/kg/min versus 22.2 mL/kg/min; P = .05). Six participants (30%) had VO2peak ≤ 16 mL/kg/min, a threshold associated with a 9-foldrisk of death in patients undergoing HCT. Despite the presence of normal (>50%) resting left ventricular ejection fraction in all participants, 25% had markedly abnormal left ventricular longitudinal strain, an advanced echocardiographic measure of myocardial dysfunction. These findings highlight the role of stress-based measures and advanced myocardial imaging to characterize CVD risk in HCT survivors, setting the stage for tailored interventions to prevent CVD with its attendant morbidity and mortality. © 2017 The American Society for Blood and Marrow Transplantation
Keywords: late effects; cardiovascular disease; survivorship; cardiovascular risk factors; hematopoietic cell transplantation; peak oxygen consumption; cardiopulmonary exercise testing
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 23
Issue: 4
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2017-04-01
Start Page: 700
End Page: 705
Language: English
DOI: 10.1016/j.bbmt.2017.01.006
PROVIDER: scopus
PMCID: PMC5348114
PUBMED: 28065839
DOI/URL:
Notes: Article -- Export Date: 4 April 2017 -- Source: Scopus
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  1. Lee Winston Jones
    130 Jones