AUTHOR=Dillon Hayley T. , Foulkes Stephen , Horne-Okano Yuki A. , Kliman David , Dunstan David W. , Daly Robin M. , Fraser Steve F. , Avery Sharon , Kingwell Bronwyn A. , La Gerche Andre , Howden Erin J. 

TITLE=Rapid cardiovascular aging following allogeneic hematopoietic cell transplantation for hematological malignancy

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.926064

DOI=10.3389/fcvm.2022.926064

ISSN=2297-055X

ABSTRACT=Allogeneic hematopoietic cell transplantation (allo-HCT) offers a potential cure for high-risk hematological malignancy; however, long-term survivors experience increased cardiovascular morbidity and mortality. It is unclear how allo-HCT impacts cardiovascular function in the short-term. Thus, this 3-month prospective study sought to evaluate the short-term cardiovascular impact of allo-HCT in hematological cancer patients, compared to an age-matched non-cancer control group. Before and ~3-months following allo-HCT, 17 hematological cancer patients (45±18years) underwent cardiopulmonary exercise testing to quantify peak oxygen uptake (VO2peak) – a measure of integrative cardiovascular function. Then, to determine the degree to which changes in VO2peak are mediated by cardiac versus non-cardiac factors, participants underwent exercise cardiac MRI (cardiac reserve), resting echocardiography (left-ventricular ejection fraction [LVEF], global longitudinal strain [GLS]), dual-energy x-ray absorptiometry (lean [LM] and fat mass [FM]), blood pressure (BP) assessment, hemoglobin sampling, and arteriovenous oxygen difference (a-vO2diff) estimation via the Fick equation. Twelve controls (43±13years) underwent identical testing at equivalent baseline and 3-month time intervals. Significant group-by-time interactions were observed for absolute VO2peak (p=0.006), weight-indexed VO2peak (p=0.02), LM (p=0.001) and cardiac reserve (p=0.02), which were driven by 26%, 24%, 6%, and 26% reductions in the allo-HCT group (all p≤0.001), respectively, as no significant changes were observed in the age-matched control group. No significant group-by-time interactions were observed for LVEF, GLS, FM, hemoglobin, BP or a-vO2diff, though a-vO2diff declined 12% in allo-HCT (p=0.028). In summary, allo-HCT severely impairs VO2peak, reflecting central and peripheral dysfunction. These results indicate allo-HCT rapidly accelerates cardiovascular aging and reinforces the need for early preventive cardiovascular intervention in this high-risk group.