Cardiovascular complications among hematopoietic cell transplantation survivors – the role of cardiomarkers

Česká verzia

Authors: Ľ. Harvanová ^1,2; V. Lábska ¹; E. Bojtárová ¹; M. Hrubiško ^1,2; A. Bátorová ¹; J. Dúbrava ³; J. Gergeľ ⁴; B. Mladosievičová ⁵
Authors place of work: Klinika hematológie a transfuziológie LF UK, LF SZU a UN Bratislava ¹; Katedra hematológie a transfuziológie, Slovenská zdravotnícka univerzita, Bratislava, Slovenská republika ²; Oddelenie funkčnej diagnostiky, UN Bratislava ³; Oddelenie klinickej biochémie, Medirex, Bratislava ⁴; Ústav patologickej fyziológie, LF UK, Bratislava ⁵
Published in the journal: Klin Onkol 2022; 35(6): 454-460
Category: Original Articles
doi: https://doi.org/10.48095/ccko2022454

Summary

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) offers potentially curative therapy for numerous malignant and nonmalignant diseases. The number of survivors and length of follow-up after successful HSCT is continually increasing. HSCT can induce damage of various organs and tissues – from minimal potentially progressive subclinical changes to life-threatening conditions. The aim of this thesis was to assess the prognostic value of high sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing and early identification of patients at high risk of a cardiac event after allogeneic HSCT. Patients and methods: Sixty-three patients with the median age of 37 years at the time of allogeneic HSCT for hematologic diseases were studied. Cardiac biomarkers were serially measured before conditioning regimen and at days 1, 14 and 30 after HSCT. Cardiac systolic and diastolic functions were assessed before the conditioning regimen and 1 month after HSCT by echocardiography. Results: The differences in plasma NT-proBNP and hs-cTnT concentrations during the 30 days following HSCT were statistically significant (P < 0.001 vs. P = 0.02). Seven of 63 patients (11.1 %) developed a cardiac event defined as cardiovascular dysrhythmias, pericarditis with cardiac tamponade and heart failure. By multivariate analysis, the strongest prognostic factor of cardiac event was an increased level of hs-cTnT and NT-proBNP persisted for a period of 14 days after HSCT (P < 0.0001). The area under the curve from hs-cTnT testing plus NT-proBNP testing together (AUC = 0.95) was superior to each diagnostic modality alone. Conclusion: Measurements of plasma NT-proBNP and hs-cTnT concentrations might be a useful tool for identification of high-risk patients requiring further cardiological follow up. Measurement of hs-cTnT plus NT-proBNP together was superior to hs-cTnT and NT-proBNP measurements alone.

Keywords:

cardiotoxicity – allogeneic hematopoietic stem cell transplantation – cardiac biomarkers – acute complications

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