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.

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接受造血干细胞移植的患者的心血管管理：从移植前到存活：美国心脏协会的科学声明

造血干细胞移植可以治愈多种疾病，但会带来心血管风险，特别是对于老年患者和患有心血管疾病的患者。心血管评估在移植前评估中至关重要，但缺乏指南。美国心脏协会的这份科学声明总结了移植相关并发症的数据，并为整个移植过程中的心血管管理提供了指导。造血干细胞移植包括4个阶段：移植前检查、调理治疗和输注、移植后即刻和长期存活。每个阶段都可能发生并发症，长期幸存者面临心血管疾病、继发性恶性肿瘤和内分泌疾病等后期影响的风险增加。在成人中，心房颤动和扑动等心律失常是最常见的急性心血管并发症。急性心力衰竭的发生率为0.4%至2.2%。在儿科患者中，左心室收缩功能障碍和心包积液是最常见的心血管并发症。影响并发症发生率和风险的因素包括移植前治疗、移植类型（自体与同种异体）、预处理方案、合并症和患者年龄。移植前心血管评估包括4个步骤：（1）初始风险分层，（2）排除高危心血管疾病，（3）心脏储备评估，（4）心血管储备优化。临床风险评分可能是成年患者风险分层的有用工具。造血干细胞移植幸存者的长期心血管管理包括优化危险因素、监测和维持评估症状心血管原因的低阈值。未来的研究应优先考虑完善风险分层并制定基于证据的指南和策略，以优化这一不断增长的患者群体的结果。