p.53 抽出テキスト
GVHD is associated with thrombosis and inflammatory myocardial damage (myocarditis, HF, conduction abnormalities, arrhythmias, and pericardial effusions), and chronic GVHD has been linked with increasing risk of hypertension, DM, and dyslipidaemia.415,416 A comprehensive CV evaluation, including NP assessment, ECG, and TTE, has become a core component of the pre-HSCT assessment409,410 to detect undiagnosed CVD, stratify CTR-CVT risk, and optimize pre-existing CV conditions.411,417–420 In early surveillance, TTE monitoring is recommended in high-risk HSCT recipients at 3 and 12 months as LVEF and GLS can decrease after transplant (see Section 7). Independent factors associated with long-term CVD in HSCT survivors are allogenic HSCT, pre-existing CVD or multiple uncontrolled CVRF, cancer treatment history (mediastinal or mantle field radiation, alkylating agents, .250 mg/m2 doxorubicin or equivalent), high-risk conditioning schemes (total body irradiation, alkylating agents), and GVHD.410 Figure 24 summarizes strategies for the prevention and attenuation of CV complications in patients undergoing HSCT. Cardiovascular surveillance in patients referred for haematopoietic stem cell transplantation If new cardiac symptoms occur at any time If new cardiac symptoms occur at any time In selected patients In selected patients Low risk Class 1 Class 1Ia Class 1Ib ECG TTE CV assessmenta NP NP ECG TTE CV assessmenta CPET 3 M after HSCT 12 M after HSCT >12 M (yearly) Before HSCT High risk Allogenic HSCT Pre-existing CVD Multiple uncontrolled CVRF Cancer treatment historyb Conditioning schemesc GVHD Figure 24 Risk factors and cardiovascular surveillance in patients referred for haematopoietic stem cell transplantation. BNP, B-type natriuretic peptide; BP, blood pressure; CPET, cardiopulmonary exercise testing; CV, cardiovascular; CVD, CV disease; CVRF, cardiovascular risk factors; ECG, electrocardiogram; GVHD, graft vs. host disease; HbA1c, glycated haemoglobin; HSCT, haematopoietic stem cell transplantation; M, months; NP, natriuretic peptides (including BNP or NT-proBNP); NT-proBNP, N-terminal pro-BNP; TTE, transthoracic echocardiography. aIncluding physical examination, BP, lipid profile, and HbA1c. bMediastinal or mantle field radiation, alkylating agents, .250 mg/m2 doxorubicin or equivalent. cTotal body irradiation, alkylating agents. Recommendation Table 22 — Recommendations for baseline risk assessment in haematopoietic stem cell transplantation patients Recommendations Classa Levelb Baseline and serial CV risk assessment (3 and 12 months, then yearly) including BP measurement, ECG, lipid measurement, and HbA1c is recommended in HSCT patients. I C Echocardiography is recommended in all patients before HSCT. I C Baseline NP measurement should be considered before HSCT.417,418 IIa C © ESC 2022 BP, blood pressure; CV, cardiovascular; ECG, electrocardiogram; HbA1c, glycated haemoglobin; HSCT, haematopoietic stem cell transplantation; NP, natriuretic peptides. aClass of recommendation. bLevel of evidence. Downloaded from academic.oup.com/eurheartj/article/43/41/4229/6673995 by guest on 07 October 2026