Korean J Pediatr.  2016 Apr;59(4):190-195. 10.3345/kjp.2016.59.4.190.

Subclinical left ventricular dysfunction in children after hematopoietic stem cell transplantation for severe aplastic anemia: a case control study using speckle tracking echocardiography

• Kim BJ
• Moon KP
• Yoon JH
• Lee EJ
• Lee JY
• Kim SK
• Lee JW
• Chung NG
• Cho B
• Kim HK

• KMID: 2163112
• DOI: http://doi.org/10.3345/kjp.2016.59.4.190

Abstract

PURPOSE
Severe aplastic anemia (SAA), a fatal disease, requires multiple transfusion, immunosuppressive therapy, and finally, hematopoietic stem cell transplantation (HSCT) as the definitive treatment. We hypothesized that iron overloading associated with multiple transfusions and HSCTrelated complications may adversely affect cardiac function. Left ventricular (LV) function was assessed in children after HSCT for SAA.
METHODS
Forty-six consecutive patients with a median age of 9.8 years (range, 1.5-18 years), who received HSCT for SAA and who underwent comprehensive echocardiography before and after HSCT, were included in this study. The data of LV functional parameters obtained using conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were collected from pre- and post-HSCT echocardiography. These data were compared to those of 40 age-matched normal controls.
RESULTS
In patients, the LV ejection fraction, shortening fraction, end-diastolic dimension, mitral early diastolic E velocity, TDI mitral septal E' velocity, and STE LV longitudinal systolic strain rate (SSR) decreased significantly after HSCT. Compared to normal controls, patients had significantly lower post-HSCT early diastolic E velocity and E/A ratio. On STE, patients had significantly decreased LV deformational parameters including LV longitudinal systolic strain (SS), SSR, and diastolic SR (DSR), and circumferential SS and DSR. Serum ferritin levels showed weak but significant correlations (P<0.05) with LV longitudinal SS and SSR and circumferential SS and DSR.
CONCLUSION
Subclinical LV dysfunction is evident in patients after HSCT for SAA, and was associated with increased iron load. Serial monitoring of cardiac function is mandatory in this population.

Keyword

Aplastic anemia; Stem cell transplantation; Ventricular function; Speckle tracking echocardiography; Strain rate

MeSH Terms

Anemia, Aplastic*
Case-Control Studies*
Child*
Echocardiography*
Ferritins
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Iron
Iron Overload
Stem Cell Transplantation
Ventricular Dysfunction, Left*
Ventricular Function
Ferritins
Iron