Effect of enalapril on left ventricular longitudinal strain in patients with hematologic malignancies after bone marrow transplantation

• Published in: European heart journal Vol. 41; no. Supplement_2
• Main Authors: Katogiannis, K, Ikonomidis, I, Stamouli, M, Makavos, G, Frogoudaki, A, Vrettou, A.R, Birba, D, Thymis, I, Tsilivarakis, D, Liori, S, Tsirigotis, P, Iliodromitis, E.K
• Format: Journal Article
• Language: English
• Published: 01.11.2020
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/ehjci/ehaa946.3268

Abstract Background and aims Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with Angiotensin Converter Enzyme inhibitor (ACE-i) enalapril could prevent cardiotoxicity. Patients and methods 60 patients (mean age 46,3±12,9 years old, 19 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation and were randomized to receive 2,5 mg enalapril bid daily or placebo. We measured at baseline, before transplantation, and after three months: i) Global Longitudinal Strain of left ventricle (LV) (GLS), ii) Left Ventricular Epicardial Strain (GLSepi), iii) Left Ventricular Endocardial Strain GLSendo), by speckle tracking imagind iv) Left Ventricular End Diastolic Volume, Left Ventricular End Systolic Volume and Left Ventricular Ejection Fraction (LVEF-Simpson's Method). Results The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication befeor and after bone marroe transplantation. Compared to baseline, patients treated with enalapril did not show a deterioration of LV GLS and GLSepi [(GLS = −20.2±3.6% vs 19.7±3.7%, p=0.540), (GLSepi = −17.9±3.1% vs −17.2±3.2%, p=0.422)], Conversely, patients treated with placebo group, presented a significant impairment of LV GLS and GLSepi [(GLS = −20.2±1.8% vs 18.9±2.1%, p=0.041, GLSepi = −17.8±1.5% vs −16.6±1.7%, p=0.028)] three months after bone marrow transplantation. No significant changes were found in LVEF after treatment with enalapril (58.6±17.6% vs 59.4±9.2%, p=0.692) or the placebo (59.4±6.6% vs 59.7±6.8%, p=0.892). Conclusions Treatment with enalapril prevented deterioration of myocardial deformation three months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction. Funding Acknowledgement Type of funding source: None