Reduced cardiovascular reserve capacity in long-term allogeneic stem cell transplant survivors.
Hayley T Dillon; Stephen Foulkes; Yuki A Horne-Okano; David Kliman; David W Dunstan; Robin M Daly; Steve F Fraser; Sharon Avery; Bronwyn A Kingwell; Andre La Gerche; Erin J Howden
Abstract
Premature cardiovascular mortality is increased in long-term allogeneic stem cell transplant (allo-SCT) survivors, but little information exists regarding subclinical cardiovascular dysfunction in this population. We compared peak oxygen uptake ([Formula: see text]O), a prognostic cardiovascular marker, and its determinants between long-term allo-SCT survivors and non-cancer controls. Fourteen allo-SCT survivors (mean ± SD, 44 ± 15 years, 50% male, median time since allo-SCT: 6.5 years [range 2-20]) and 14 age- and sex-matched controls (46 ± 13 years, 50% male) underwent cardiopulmonary exercise testing to quantify [Formula: see text]O. Resting echocardiography (left-ventricular ejection fraction and strain), exercise cardiac MRI (peak cardiac and stroke volume index [CI, SVI]), biochemistry (hemoglobin, troponin-I, B-natriuretic peptide), dual-energy x-ray absorptiometry (lean [LM] and fat [FM] mass, percent body fat [%BF]) and Fick-principal calculation (arteriovenous oxygen difference) were also performed. Survivors exhibited impaired [Formula: see text]O as compared with controls (25.9 ± 5.1 vs. 33.7 ± 6.5 ml kg min, p = 0.002), which coincided with reduced CI (6.6 ± 0.8 vs. 8.6 ± 1.9 L min m; p = 0.001) secondary to reduced SVI (48 ± 4 vs. 61 ± 8 ml m; p < 0.001) rather than chronotropic impairment, and higher %BF (difference, 7.9%, p = 0.007) due to greater FM (5.8 kg; p = 0.069) and lower LM (4.3 kg, p = 0.25). All other measures were similar between groups. Despite comparable resting cardiac function and biomarker profiles, survivors exhibited reduced [Formula: see text]O and exercise cardiac function and increased %BF relative to controls. These results highlight potential therapeutic avenues and the utility of exercise-based cardiovascular assessment in unmasking cardiovascular dysfunction in allo-SCT survivors.2peak
Journal | SCIENTIFIC REPORTS |
ISSN | 2045-2322 |
Published | 06 Feb 2023 |
Volume | 13 |
Issue | 1 |
Pages | 2112 2112 |
DOI | 10.1038/s41598-023-28320-w |
Type | Journal Article | Research Support, Non-U.S. Gov't |
Sponsorship |