Beating Hearts, Beating Cancer

Children undergoing hematopoietic cell transplantation (HCT) have high rates of tachycardia, or fast heart rates, which were associated with the development of systolic and diastolic myocardial dysfunction, according to research published in Bone Marrow Transplantation by Le Bonheur Pediatric Cardiologist Jason Goldberg, MD, MS, and colleagues. University of Tennessee Health Science Center and Le Bonheur Heart Institute cardiologists care for children who receive cancer therapy at St. Jude Children’s Research Hospital. This research can help clinicians more closely evaluate and identify issues with heart function among children who receive HCT.

“We have to understand the early risk factors for development of cardiac dysfunction in pediatric HCT as we know that recipients of HCT during childhood are at increased risk of accelerated cardiovascular morbidity and mortality later in life,” said Goldberg.

The study reviewed 80 pediatric patients who had allogenic (non-self) HCT between 2015 and 2019 at St. Jude Children’s Research Hospital. All patients had echocardiograms at baseline (within 60 days prior to infusion), early post-HCT (between infusion and 90 days post-infusion) and at one year of follow-up (within 90 days of one year after infusion).

In the early post-HCT time period, 64% of patients had tachycardia, 25% had systolic (pumping) dysfunction and 48% had diastolic (relaxing) dysfunction. Patients with tachycardia were 13 times more likely to develop systolic dysfunction and four times more likely to develop diastolic dysfunction.

We have to understand the early risk factors for development of cardiac dysfunction in pediatric HCT as we know that recipients of HCT during childhood are at increased risk of accelerated cardiovascular morbidity and mortality later in life.

Other risk factors for cardiac dysfunction included patients who received anthracyclines prior to HCT; those patients were seven times more likely to have early tachycardia. Systolic dysfunction was also more prevalent in the female gender and patients who received ace-inhibitor therapy pre-transplant.

“Tachycardia likely exists as a marker of systemic inflammation,” said Goldberg. “This, together with other acute post-HCT derangements and previous cardiovascular insults from known cardiotoxic agents, may result in cardiac dysfunction.”

These findings can assist in creating a cardiovascular assessment protocol for post-HCT patients to help prevent and treat early myocardial dysfunction. In addition, this research can inform longer-term investigations to determine whether these early cardiovascular abnormalities are related to late cardiovascular morbidity.