Longitudinal Changes in Cardiac Function Following Autologous Stem Cell Transplantation in Diffuse Systemic Sclerosis
Abstract
OBJECTIVE: Cardiovascular involvement is frequent in patients with systemic sclerosis (SSc). Autologous stem cell transplantation (ASCT) has emerged as a disease-modifying therapy for diffuse SSc, but its long-term impact on cardiac function remains unclear. We aim to examine the changes in left ventricular (LV) function after ASCT and their potential prognostic significance. METHODS: From the Leiden Systemic Sclerosis cohort, 43 patients with diffuse SSc who underwent ASCT were matched 1:1 with controls with SSc based on sex, age, and disease duration. Patients with overt cardiac or pulmonary involvement were excluded. Serial echocardiography was performed annually, including LV ejection fraction (LVEF), global longitudinal strain (GLS), and diastolic parameters. RESULTS: Among the included patients, mean age was 44.1 ± 10.5 years; 52.3% were female. At baseline, patients with ASCT showed mildly reduced LVEF (52.5% ± 9.1% vs 56.1% ± 6.3%, P = 0.044) and LV GLS (18.0% ± 2.6% vs 19.5% ± 2.5%, P = 0.014) compared to controls. During follow-up, ASCT was associated with significant improvement in LVEF (adjusted β = 1.59%/y, P < 0.001) and GLS (adjusted β = 0.71%/y, P < 0.001), whereas controls showed progressive decline. Diastolic parameters remained stable over time in both groups. Time-dependent changes in LV GLS, but not LVEF, were independently associated with all-cause mortality (adjusted hazard ratio 0.73 per %, 95% confidence interval 0.61-0.86, P = 0.0002). CONCLUSION: In patients with diffuse SSc, ASCT is associated with significant improvements in cardiac systolic function over time without adverse effects on diastolic function. These findings support the cardiac safety of ASCT, suggest potential cardiovascular benefit beyond systemic disease control, and highlight the importance of longitudinal monitoring with advanced echocardiography in SSc.
Authors 7
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Leiden University Medical Center · The First Affiliated Hospital, Sun Yat-sen University
Affiliation as printed
Department of Cardiology First Affiliated Hospital of Sun Yat‐sen University Guangzhou China
Department of Cardiology Leiden University Medical Center Leiden the Netherlands
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Steele C. Butcher Aachen Department of Cardiology Leiden University Medical Center Leiden The Netherlands
Royal Perth Hospital · Leiden University Medical Center
Affiliation as printed
Department of Cardiology Leiden University Medical Center Leiden the Netherlands
Department of Cardiology Royal Perth Hospital Perth Western Australia Australia
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Leiden University Medical Center · Beijing Anzhen Hospital
Affiliation as printed
Department of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease Beijing China
Department of Cardiology Leiden University Medical Center Leiden the Netherlands
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Saad Ahmed Aachen Department of Rheumatology Leiden University Medical Center Leiden The Netherlands
Leiden University Medical Center
Affiliation as printed
Department of Rheumatology Leiden University Medical Center Leiden the Netherlands
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Jeroen Joost Bax Aachen Department of Cardiology Leiden University Medical Center Leiden The Netherlands
University of Turku · Leiden University Medical Center · Turku University Hospital
Affiliation as printed
Department of Cardiology Leiden University Medical Center Leiden the Netherlands
Department of Cardiology University of Turku and Turku University Hospital Turku Finland
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Jeska Kirsten De Vries-Bouwstra Aachen Department of Rheumatology Leiden University Medical Center Leiden The Netherlands
Leiden University Medical Center
Affiliation as printed
Department of Rheumatology Leiden University Medical Center Leiden the Netherlands
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Nina Ajmone Marsan corresponding Aachen Department of Cardiology Leiden University Medical Center Leiden The Netherlands
Leiden University Medical Center
Affiliation as printed
Department of Cardiology Leiden University Medical Center Leiden the Netherlands
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