The utility of novel echocardiographic techniques in evaluating cardiac function in patients undergoing hematopoietic stem cell transplantation: a pilot study

Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many refractory malignancies, bone marrow failure syndromes and primary immune deficiencies in children. Cardiomyopathy and heart failure are well described late complications of HSCT. By the time they manifest clinically, a significant and irreversible damage to the myocardium has occurred with resultant substantial morbidity and mortality. This study aims to evaluate subclinical cardiac affection by using conventional echocardiography, two-dimensional (2D) speckle tracking and three-dimensional (3D) Echo among patients before and after Hematopoietic Stem Cell Transplantation. A prospective case control study was conducted from 2022 to 2023 on 25 patients who underwent bone marrow transplantation and 25 controls. Demographic, clinical data were collected. Echocardiography was performed, including LV functional assessment using conventional echocardiography, 2D speckle tracking, and 3D echocardiography. The mean age of the patients was 9.8 years. Neuroblastoma was the most common indication for transplantation, accounting for 44% of cases, while only 4% of patients underwent transplantation for thalassemia. Significant changes were observed in fractional shortening (FS), global longitudinal strain (GLS), segmental myocardial strain parameters, and 3D ejection fraction (3D EF) before and after transplantation. FS showed a significant correlation with the cumulative dose of cyclophosphamide, while GLS average was significantly associated with disease duration, cumulative doses of cyclophosphamide, and doxorubicin. Additionally, 3D EF demonstrated significant correlations with these factors. GLS average, lateral longitudinal strain at the base, and 3D EF differed significantly between autologous and allogeneic transplant recipients. This study demonstrates significant changes in cardiac function following HSCT, with alterations in fractional shortening, global and segmental myocardial strain, and 3D ejection fraction. 3D echocardiography proved effective in detecting these changes.