1. Cardiovascular Management of Patients Undergoing Hematopoietic Stem Cell Transplantation: From Pretransplantation to Survivorship: A Scientific Statement From the American Heart Association
- Author
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Hayek, Salim S, Zaha, Vlad G, Bogle, Carmel, Deswal, Anita, Langston, Amelia, Rotz, Seth, Vasbinder, Alexi, Yang, Eric, Okwuosa, Tochukwu, and Nursing, on behalf of the American Heart Association Cardio-Oncology Committee of the Council on Clinical Cardiology and Council on Genomic and Precision Medicine and the Council on Cardiovascular and Stroke
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease ,Hematology ,Cancer ,Cardiovascular ,Pediatric ,Stem Cell Research - Nonembryonic - Human ,Aging ,Regenerative Medicine ,Stem Cell Research ,Clinical Research ,Patient Safety ,Transplantation ,Prevention ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Adult ,Humans ,Child ,Aged ,Cardiovascular Diseases ,Survivorship ,American Heart Association ,Transplantation Conditioning ,Hematopoietic Stem Cell Transplantation ,Heart Diseases ,AHA Scientific Statements ,arrhythmias ,cardiac ,atherosclerosis ,bone marrow transplantation ,heart failure ,risk assessment ,American Heart Association Cardio-Oncology Committee of the Council on Clinical Cardiology and Council on Genomic and Precision Medicine ,and the Council on Cardiovascular and Stroke Nursing ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Abstract
Hematopoietic stem cell transplantation can cure various disorders but poses cardiovascular risks, especially for elderly patients and those with cardiovascular diseases. Cardiovascular evaluations are crucial in pretransplantation assessments, but guidelines are lacking. This American Heart Association scientific statement summarizes the data on transplantation-related complications and provides guidance for the cardiovascular management throughout transplantation. Hematopoietic stem cell transplantation consists of 4 phases: pretransplantation workup, conditioning therapy and infusion, immediate posttransplantation period, and long-term survivorship. Complications can occur during each phase, with long-term survivors facing increased risks for late effects such as cardiovascular disease, secondary malignancies, and endocrinopathies. In adults, arrhythmias such as atrial fibrillation and flutter are the most frequent acute cardiovascular complication. Acute heart failure has an incidence ranging from 0.4% to 2.2%. In pediatric patients, left ventricular systolic dysfunction and pericardial effusion are the most common cardiovascular complications. Factors influencing the incidence and risk of complications include pretransplantation therapies, transplantation type (autologous versus allogeneic), conditioning regimen, comorbid conditions, and patient age. The pretransplantation cardiovascular evaluation consists of 4 steps: (1) initial risk stratification, (2) exclusion of high-risk cardiovascular disease, (3) assessment of cardiac reserve, and (4) optimization of cardiovascular reserve. Clinical risk scores could be useful tools for the risk stratification of adult patients. Long-term cardiovascular management of hematopoietic stem cell transplantation survivors includes optimizing risk factors, monitoring, and maintaining a low threshold for evaluating cardiovascular causes of symptoms. Future research should prioritize refining risk stratification and creating evidence-based guidelines and strategies to optimize outcomes in this growing patient population.
- Published
- 2024