Abnormal circumferential strain measured by echocardiography is present in patients with Shwachman-Diamond syndrome despite normal shortening fraction.
BACKGROUND
Shwachman-Diamond Syndrome (SDS) is an autosomal recessive disorder characterized by bone marrow failure and exocrine pancreatic dysfunction. Heart failure has been described in patients with SDS. Circumferential strain (ε(cc)) is a measure of cardiac performance that may identify dysfunction when standard measures are normal.


METHODS
Patients with SDS were identified and the echocardiographic database queried. Cardiac anatomy and function were recorded, and ε(cc) was measured retrospectively.


RESULTS
From 1995-2013, 27 patients with biallelic SBDS mutations confirming the diagnosis of SDS were identified at our institution: 14 had at least one echocardiogram available; 10 underwent HSCT, with echocardiograms available in nine. Ejection fraction (EF) was normal in all 14 patients evaluated; however, ε(cc) was decreased in 4/12 studies prior to HSCT. In two patients, ε(cc) was abnormal both before and after HSCT, in one, ε(cc) changed from normal to abnormal after HSCT, and in one, ε(cc) was normal after HSCT despite being abnormal prior. Echocardiogram reports were also available for six patients in the North American SDS registry, all with normal EF.


CONCLUSIONS
While EF was normal in all patients with SDS, ε(cc) was abnormal in 33% prior to HSCT and 33% of those who had undergone HSCT. This suggests that SDS is associated with systolic dysfunction. Further studies are needed to define the incidence of dysfunction in this group and the progression to heart failure.
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Thomas D
TD
Ryan
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
John L
JL
Jefferies
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Clifford
C
Chin
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Joshua J
JJ
Sticka
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Michael D
MD
Taylor
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Richard
R
Harris
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Joan
J
Moore
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Erica
E
Goodridge
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Leann
L
Mount
Department of Medicine, University of Washington, The Severe Chronic Neutropenia International Registry, Seattle, Washington.
Audrey A
AA
Bolyard
Department of Medicine, University of Washington, Seattle, Washington.
Barbara
B
Otto
Department of Medicine, University of Washington, Seattle, Washington.
Amanda
A
Jones
Puget Sound Blood Center, Seattle, Washington.|Department of Pediatrics, University of Washington, Seattle, Washington.|Seattle Children's Hospital, Seattle, Washington.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Akiko
A
Shimamura
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Stella
S
Davies
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Kasiani
K
Myers
D000293:Adolescent; D000328:Adult; D001855:Bone Marrow Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007223:Infant; D008068:Lipomatosis / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D000081003:Shwachman-Diamond Syndrome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*; D055815:Young Adult
Shwachman-Diamond syndrome (SDS); cardiomyopathy; echocardiography; heart failure; hematopoietic stem cell transplant