Cryopreserved graft administration may be associated with early alterations in left ventricular diastolic function potentially reflecting DMSO-related cardiotoxicity, and GLS appears to be a sensitive marker for the early detection and prediction of cardiotoxicity in patients undergoing allogeneic HSCT.
Key Findings
Results
Symptomatic cardiovascular toxicity occurred in 5.2% of patients and subclinical cancer therapy-related cardiac dysfunction was detected in 16.7% of patients within 30 days of allogeneic HSCT.
Study included 96 consecutive patients with a median age of 46 years undergoing allogeneic HSCT.
Symptomatic cardiovascular toxicity occurred in 5 patients (5.2%) during the 30-day follow-up period.
Subclinical cancer therapy-related cardiac dysfunction was detected in 16 patients (16.7%).
This was a prospective study design.
Results
Global longitudinal strain (GLS) predicted cardiotoxicity with high accuracy in patients undergoing allogeneic HSCT.
ROC analysis demonstrated GLS predicted cardiotoxicity with an AUC of 0.88 (95% CI, 0.79–0.98; p < 0.0001).
At a cut-off value of -16.8%, GLS achieved a sensitivity of 100% and specificity of 79%.
GLS was identified as 'a sensitive marker for the early detection and prediction of cardiotoxicity.'
Results
In the cryopreserved graft group, E/A ratio decreased below the normal range and E/E' ratio increased significantly after HSCT, whereas no such changes were observed in the non-cryopreserved group.
Patients were divided into cryopreserved (n = 59, 61.5%) and non-cryopreserved (n = 37, 38.5%) groups.
The E/A ratio decreased below the normal range specifically in the cryopreserved group.
The E/E' ratio increased significantly in the cryopreserved group post-transplantation.
No significant changes in E/A or E/E' were observed in the non-cryopreserved group.
These diastolic changes in the cryopreserved group were interpreted as potentially reflecting DMSO-related cardiotoxicity.
Results
Significant post-HSCT changes were observed across multiple echocardiographic parameters including diastolic parameters, structural parameters, GLS, and right ventricular ejection fraction.
Comprehensive echocardiographic assessment was performed before and after transplantation in all 96 patients.
Significant changes were observed in diastolic parameters E/A and E/E'.
Structural parameters including left ventricular mass and left ventricular mass index changed significantly.
Global longitudinal strain (GLS) and right ventricular ejection fraction also showed significant changes following HSCT.
Background
Use of cryopreserved grafts in allogeneic HSCT increased substantially during the COVID-19 pandemic, motivating study of DMSO-related cardiac effects.
DMSO is used as a cryoprotective agent and is well recognized for its infusion-related toxicity.
The impact of DMSO specifically on cardiac function was described as 'unclear' prior to this study.
The COVID-19 pandemic drove increased use of cryopreserved grafts, providing clinical context for this investigation.
61.5% of the study cohort received cryopreserved grafts, reflecting contemporary clinical practice.
What This Means
This research examined whether a chemical called dimethyl sulfoxide (DMSO), which is used to preserve stem cell grafts by freezing, might harm the heart in patients receiving stem cell transplants from donors. The study followed 96 patients and used ultrasound imaging of the heart (echocardiography) before and after transplantation to look for changes in heart function. Patients who received frozen (cryopreserved) grafts containing DMSO showed specific worsening in how the heart's left ventricle relaxes and fills with blood — a type of dysfunction called diastolic impairment — while patients who received fresh (non-cryopreserved) grafts did not show these same changes. Overall, about 1 in 6 patients developed subtle, symptom-free heart dysfunction detectable only by testing, and about 1 in 20 developed noticeable cardiac symptoms within 30 days.
This research suggests that a specific heart imaging measurement called global longitudinal strain (GLS) — which detects subtle changes in how the heart muscle stretches and contracts — is a highly accurate tool for predicting which patients will develop heart problems after transplantation. At a particular threshold value, GLS correctly identified all patients who went on to develop cardiotoxicity (100% sensitivity) while correctly ruling it out in most patients who did not (79% specificity). This makes GLS a potentially valuable monitoring tool in this patient population.
The findings matter because stem cell transplantation is a life-saving treatment for blood cancers and other serious diseases, but it carries risks including heart damage. The COVID-19 pandemic led to more widespread use of frozen grafts, making it more important to understand the cardiac risks associated with DMSO. This research suggests that clinicians may want to pay particular attention to heart function monitoring — especially using GLS — in patients receiving cryopreserved grafts, as early detection of cardiac changes could allow for timely intervention.