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 VO2peakafter 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). VO2peakwas on average 22% less than predicted, and allogeneic HCT survivors had markedly lower VO2peakwhen 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.
authors.affiliation: Department of Population Sciences, City of Hope, Duarte, California. Electronic address: sarmenian@coh.org.
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.affiliation: Pulmonary and Critical Care Medicine, City of Hope, Duarte, California.
authors.forename: David
authors.initials: D
authors.lastname: Horak
authors.affiliation: University of Texas Medical Branch, NASA Johnson Space Center, Houston, Texas.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Scott
authors.affiliation: Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: George
authors.initials: G
authors.lastname: Mills
authors.affiliation: Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: Aida
authors.initials: A
authors.lastname: Siyahian
authors.affiliation: Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Berano Teh
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
authors.affiliation: Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Lee W
authors.initials: LW
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D005080:Exercise Test / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010101:Oxygen Consumption; D012129:Respiratory Function Tests; D013318:Stroke Volume; D017741:Survivors; D018487:Ventricular Dysfunction, Left
keywords: Cardiopulmonary exercise testing; Cardiovascular disease; Cardiovascular risk factors; Hematopoietic cell transplantation; Late effects; Peak oxygen consumption; Survivorship