IMPACT OF AUTOLOGOUS STEM CELL TRANSPLANTATION ON CARDIAC PERFORMANCE IN SYSTEMIC SCLEROSIS

Aim:
Systemic sclerosis (SSc) is a connective tissue disorder with frequent cardiac involvement. Autologous stem-cell transplantation (ASCT) showed to improve symptoms and survival in SSc, but its impact on cardiac function remains unknown.

Sample and Methodology:
Consecutive SSc patients undergoing ASCT were included and matched 1:1 with controls using propensity scores adjusting for sex, age and disease duration. Echocardiography was performed before ASCT and then annually: left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LV-GLS), and diastolic function parameters were measured. Linear mixed-effect models were used to analyze their changes over time.

Results:
A total of 86 patients (n=43 per each group) were included. Both LVEF and LV-GLS were comparable between ASCT patients and controls at baseline, but significantly improved (LVEF: β 1.59%, 95% confidence interval CI [0.84, 2.34], interaction p< 0.001; LV-GLS: β -0.71%, 95% CI [-0.43, -0.99], interaction p< 0.001) in the ASCT group at the third year and at last follow-up, while worsened over time in the controls (Figure). In turn, LV diastolic function parameters, including EA ratio, tricuspid regurgitation velocity, E/e’, and left atrial volume index showed no significant changes over time in both groups.

Conclusion:
In SSc patients, ASCT showed a favorable impact on LV systolic function. Myocardial response to this treatment should be monitored over time by using echocardiographic measures such as LV-GLS.