title: The injured heart: early cardiac effects of hematopoietic stem cell transplantation in children and young adults.
abstract: We hypothesized that subclinical cardiac injury in the peri-transplant period is more frequent than currently appreciated in children and young adults. We performed echocardiographic screening on 227 consecutive patients prior to hematopoietic stem cell transplantation (HSCT), and 7, 30 and 100 days after transplant. We measured cardiac biomarkers cardiac troponin-I (cTn-I), and soluble suppressor of tumorigenicity 2 (sST2) prior to transplant, during conditioning, and days +7, +14, +28 and +49 in 26 patients. We subsequently analyzed levels of cTn-I every 48-72 h in 15 consecutive children during conditioning. Thirty-two percent (73/227) of patients had a new abnormality on echocardiogram. New left ventricular systolic dysfunction (LVSD) occurred in 6.2% of subjects and new pericardial effusion in 27.3%. Eight of 227 (3.5%) patients underwent pericardial drain placement, and 5 (2.2%) received medical therapy for clinically occult LVSD. cTn-I was elevated in 53.0% of all samples and sST2 in 38.2%. At least one sample had a detectable cTn-I in 84.6% of patients and an elevated sST2 in 76.9%. Thirteen of fifteen patients monitored frequently during condition had elevation of cTn-I. Echocardiographic and biochemical abnormalities are frequent in the peri-HSCT period. Echocardiogram does not detect all subclinical cardiac injuries that may become clinically relevant over longer periods.
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rotz
authors.affiliation: Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Ryan
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jodele
authors.affiliation: Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Jefferies
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Lane
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Pate
authors.affiliation: Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hirsch
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Hlavaty
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Levesque
authors.affiliation: Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Taylor
authors.affiliation: Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: Cash
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Myers
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: El-Bietar
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Davies
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Dandoy
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D019210:Troponin I