Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies

Abstract

High-dose chemotherapy (HDC) followed by stem cell transplantation (HSCT) is a well-established method in patients with hematological malignancies, and for last few years, many efforts have been made to estimate short- and long-term efficacy of this method, as well as early and late complications. The present study concentrates on cardiotoxic effects, mainly early changes using biochemical markers such as N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn). Simultaneously, the analysis of 12-lead ECG was done before and after the procedure in which the novel repolarization markers: Tp–e and Tp–e/QT ratio were measured, together with standard markers: QT, QTc. It was found that NT-pro BNP was significantly increased after HSCT in comparison to results before it, and no significant changes were present in Troponin levels. Simultaneously, Tp–e interval and Tp–e/QT ratio were significantly higher after HSCT. The use of cyclophosphamide, advanced age, and higher level of blood cholesterol concentration were risk factors for the increase in NT-proBNP and treatment with cyclophosphamide as well as fludarabine and higher creatinine levels were risk factors for the increase in Tp–e/QT ratio. In conclusion, in the early term evaluation after HSCT in patients with no previously diagnosed heart disease, the mild changes in markers of heart overload and repolarization were noted. The observations suggest that in all patients undergoing HSCT, even the ones without pre-existing cardiovascular disease, the evaluation, and monitoring of heart function should be considered.

Association between B-type natriuretic peptide levels after the first dose of cyclophosphamide and early cardiac events and transplantation outcomes

“…25 However, the speci city of aberrant electrocardiographic ndings to indicate PTCy-induced cardiotoxicity is challenging because the conditioning regimen and HSCT procedure may generally cause mild cardiac effects and change the electrocardiographic morphology. 13 Echocardiography ndings, including changes in the E/A ratio, intraventricular septum thickness, left ventricular diameter, and early functional mitral regurgitation, are associated with cardiotoxicity after cyclophosphamide administration. 26,27 BNP and troponin I or T are circulating cardiac markers that are convenient for monitoring cardiotoxicity.…”

“…N-terminal pro-B-type natriuretic peptide (BNP) and troponin I are biochemical markers of heart failure and myocardial infarction, respectively. 13 BNP is secreted by myocardial cells in response to increased pressure and volume. They play an important role in predicting future cardiac events, especially in coronary artery diseases.…”