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Taqueti VR, Shah AM, Everett BM, Pradhan AD, Piazza G, Bibbo C, Hainer J, Morgan V, Carolina do A. H. de Souza A, Skali H, Blankstein R, Dorbala S, Goldhaber SZ, Le May MR, Chow BJ, deKemp RA, Hage FG, Beanlands RS, Libby P, Glynn RJ, Solomon SD, Ridker PM, Di Carli MF. Coronary Flow Reserve, Inflammation, and Myocardial Strain: The CIRT-CFR Trial. JACC Basic Transl Sci 2023; 8:141-151. [PMID: 36908662 PMCID: PMC9998473 DOI: 10.1016/j.jacbts.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Inflammation is a key determinant of cardiovascular outcomes, but its role in heart failure is uncertain. In patients with cardiometabolic disease enrolled in the prospective, multicenter ancillary study of CIRT (Cardiovascular Inflammation Reduction Trial), CIRT-CFR (Coronary Flow Reserve to Assess Cardiovascular Inflammation), impaired coronary flow reserve was independently associated with increased inflammation and myocardial strain despite well-controlled lipid, glycemic, and hemodynamic profiles. Inflammation modified the relationship between CFR and myocardial strain, disrupting the association between cardiac blood flow and function. Future studies are needed to investigate whether an early inflammation-mediated reduction in CFR capturing microvascular ischemia may lead to heart failure in patients with cardiometabolic disease. (Cardiovascular Inflammation Reduction Trial [CIRT]; NCT01594333; Coronary Flow Reserve to Assess Cardiovascular Inflammation [CIRT-CFR]; NCT02786134).
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Key Words
- BMI, body mass index
- CAD, coronary artery disease
- CFR, coronary flow reserve
- CT, computed tomography
- GLS, global longitudinal strain
- HDL, high-density lipoprotein cholesterol
- HFpEF, heart failure with preserved ejection fraction
- IL, interleukin
- LDL, low-density lipoprotein cholesterol
- LDM, low-dose methotrexate
- LVEF, left ventricular ejection fraction
- MBF, myocardial blood flow
- MI, myocardial infarction
- NHLBI, National Heart, Lung, and Blood Institute
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PET, positron emission tomography
- cardiometabolic disease
- cardiovascular trial coronary flow reserve
- coronary microvascular dysfunction
- heart failure
- hsCRP, high-sensitivity C-reactive protein
- hsTNT, high-sensitivity troponin T
- inflammation
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Affiliation(s)
- Viviany R. Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amil M. Shah
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan M. Everett
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aruna D. Pradhan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney Bibbo
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria Morgan
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Carolina do A. H. de Souza
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hicham Skali
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Z. Goldhaber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michel R. Le May
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Benjamin J.W. Chow
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Robert A. deKemp
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Fadi G. Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Rob S. Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Peter Libby
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Glynn
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott D. Solomon
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul M. Ridker
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcelo F. Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Yeung T, McLean C, Kaye DM, Leet A, Patel HC, Bergin P, Cheshire C, Hare JL, Taylor AJ, Gutman S. Immune Checkpoint Inhibitor Myocarditis and Cellular Rejection in Orthotopic Heart Transplant Recipients. JACC CardioOncol 2022; 4:717-21. [PMID: 36636444 DOI: 10.1016/j.jaccao.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022] Open
Key Words
- ACR, acute cellular rejection
- CNI, calcineurin inhibitor
- CTLA-4, cytotoxic T-lymphocyte-associated antigen-4
- EMB, endomyocardial biopsy
- ICI, immune checkpoint inhibitor
- ISHLT, International Society for Heart and Lung Transplantation
- LVEF, left ventricular ejection fraction
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PD-1, programmed cell death protein-1
- PET, positron emission tomography
- SOT, solid organ transplant
- TTE, transthoracic echocardiogram
- heart failure
- immunotherapy
- mTOR, mammalian target of rapamycin
- myocarditis
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Ramayya T, Mitchell JD, Hartupee JC, Lavine K, Ridley CH, Kotkar KD, Jimenez J, Lin CY, Alvarez-Cardona JA, Krone RK, Campbell CM. Delayed Diagnosis and Recovery of Fulminant Immune Checkpoint Inhibitor-Associated Myocarditis on VA-ECMO Support. JACC CardioOncol 2022; 4:722-726. [PMID: 36636445 PMCID: PMC9830207 DOI: 10.1016/j.jaccao.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022] Open
Key Words
- CMR, cardiac magnetic resonance
- ICI, immune checkpoint inhibitor
- IRAE, immune-related adverse event
- IV, intravenous
- IVIG, intravenous immunoglobulin
- LGE, late gadolinium enhancement
- LVEF, left ventricular ejection fraction
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- TTE, transthoracic echocardiogram
- T cell
- VA-ECMO, venoarterial extracorporeal membrane oxygenation
- abatacept
- cardiac arrest
- cardiogenic shock
- cervical cancer
- extracorporeal membrane oxygenation
- fulminant
- heart failure
- hsTnI, high-sensitivity troponin I
- immune
- immune checkpoint inhibitor
- immunosuppressive
- inflammation
- inflammatory
- myocarditis
- troponin
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Affiliation(s)
- Tarun Ramayya
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joshua D. Mitchell
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Justin C. Hartupee
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kory Lavine
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Clare H. Ridley
- Department of Anesthesiology, Washington University in St. Louis. St. Louis, Missouri, USA
| | - Kunal D. Kotkar
- Cardiothoracic Surgery Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jesus Jimenez
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Chieh-Yu Lin
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Pathology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jose A. Alvarez-Cardona
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ronald K. Krone
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Courtney M. Campbell
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
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4
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Liu QQ, Yang J, Lu D, Xu XQ, Jiang X, Wang H, Li JY, Guo F, Zhu YL, Zhao QH. Time-Velocity Integral of Left Ventricular Outflow Tract Predicts Worse Long-Term Survival in Pulmonary Arterial Hypertension. JACC Asia 2022; 2:235-243. [PMID: 36338398 PMCID: PMC9627844 DOI: 10.1016/j.jacasi.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The time-velocity integral of the left ventricular outflow tract (TVILVOT) has been demonstrated to correlate with heart failure hospitalization and mortality, but the association of TVILVOT with the severity and prognosis of pulmonary arterial hypertension (PAH) has not been evaluated. OBJECTIVES The aim of this study was to investigate the predictive value of baseline TVILVOT in PAH. METHODS A total of 225 consecutive patients with a diagnosis of incident PAH were prospectively studied and echocardiology-derived TVILVOT was measured at enrollment followed by right heart catheterization examination within 48 hours. Cox proportional hazards analysis was performed to assess the association between baseline variables and mortality. RESULTS During a median follow-up period of 33.8 months, 44 patients died of cardiovascular events. Baseline TVILVOT was significantly lower in the nonsurvivors compared with the survivors (P < 0.001). Baseline TVILVOT was positively correlated with stroke volume obtained by right heart catheterization (r = 0.709; P < 0.001), and inversely correlated with N-terminal pro-B-type natriuretic peptide (r = -0.533; P < 0.001), pulmonary vascular resistance (r = -0.423; P < 0.001). Multivariate analysis showed that baseline TVILVOT (hazard ratio: 0.856; 95% CI: 0.780-0.941; P = 0.001) was an independent predictor of cardiovascular mortality in PAH. Patients with a baseline TVILVOT <17.1 cm (median value) had a significantly worse survival than those with a baseline TVILVOT ≥17.1 cm (P < 0.001). CONCLUSIONS The findings of this study suggest that noninvasive TVILVOT provides a practical method to assess the severity and predict long-term outcome of PAH.
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Key Words
- 6MWD, 6-minute walk distance
- BSA, body surface area
- CI, cardiac index
- CMR, cardiac magnetic resonance imaging
- CO, cardiac output
- HR, hazard ratio
- LV, left ventricular
- LVOT, left ventricular outflow tract
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PAH, pulmonary arterial hypertension
- PVR, pulmonary vascular resistance
- RHC, right heart catheterization
- RV, right ventricular
- STr, peak systolic tricuspid annular velocity of tissue Doppler
- SVRHC, stroke volume obtained by right heart catheterization
- TAPSE, tricuspid annular plane systolic excursion
- TTE, transthoracic echocardiography
- TVI, time-velocity integral
- TVILVOT, time-velocity integral of left ventricular outflow tract
- WHO-FC, World Health Organization functional class
- left ventricular outflow tract
- pulmonary arterial hypertension
- survival
- time-velocity integral
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Affiliation(s)
- Qian-Qian Liu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Yang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Lu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Qi Xu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Jiang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Wang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Yi Li
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Guo
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan-Lin Zhu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin-Hua Zhao
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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5
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Roh JD, Kitchen RR, Guseh JS, McNeill JN, Aid M, Martinot AJ, Yu A, Platt C, Rhee J, Weber B, Trager LE, Hastings MH, Ducat S, Xia P, Castro C, Singh A, Atlason B, Churchill TW, Di Carli MF, Ellinor PT, Barouch DH, Ho JE, Rosenzweig A. Plasma Proteomics of COVID-19-Associated Cardiovascular Complications: Implications for Pathophysiology and Therapeutics. JACC Basic Transl Sci 2022; 7:425-441. [PMID: 35530264 PMCID: PMC9067411 DOI: 10.1016/j.jacbts.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/30/2022]
Abstract
To gain insights into the mechanisms driving cardiovascular complications in COVID-19, we performed a case-control plasma proteomics study in COVID-19 patients. Our results identify the senescence-associated secretory phenotype, a marker of biological aging, as the dominant process associated with disease severity and cardiac involvement. FSTL3, an indicator of senescence-promoting Activin/TGFβ signaling, and ADAMTS13, the von Willebrand Factor-cleaving protease whose loss-of-function causes microvascular thrombosis, were among the proteins most strongly associated with myocardial stress and injury. Findings were validated in a larger COVID-19 patient cohort and the hamster COVID-19 model, providing new insights into the pathophysiology of COVID-19 cardiovascular complications with therapeutic implications.
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Affiliation(s)
- Jason D. Roh
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R. Kitchen
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J. Sawalla Guseh
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenna N. McNeill
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malika Aid
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Amanda J. Martinot
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Biomedical Sciences, Section of Pathology, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - Andy Yu
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colin Platt
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James Rhee
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brittany Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lena E. Trager
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret H. Hastings
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Ducat
- Department of Biomedical Sciences, Section of Pathology, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - Peng Xia
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Castro
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abhilasha Singh
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bjarni Atlason
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy W. Churchill
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcelo F. Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Patrick T. Ellinor
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Dan H. Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Jennifer E. Ho
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Rosenzweig
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abe H, Kosugi S, Ozaki T, Mishima T, Date M, Ueda Y, Uematsu M, Tamaki S, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Yamada T, Yasumura Y, Dohi T, Suna S, Hikoso S, Nakatani D, Koretsune Y, Sakata Y. Prognostic Impact of Echocardiographic Congestion Grade in HFpEF With and Without Atrial Fibrillation. JACC Asia 2022; 2:73-84. [PMID: 36340256 PMCID: PMC9627800 DOI: 10.1016/j.jacasi.2021.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in heart failure with preserved ejection fraction (HFpEF). OBJECTIVES This study aimed to investigate the prognostic value of echocardiographic markers of congestion that can be applied to both AF and patients without AF with HFpEF. METHODS We conducted a multicenter study of 505 patients with HFpEF admitted to hospitals for acute decompensated heart failure. The ratio of early diastolic transmitral flow velocity to mitral annulus velocity (E/e'), the tricuspid regurgitation peak velocity, and the collapsibility of the inferior vena cava were obtained at discharge. Congestion was determined by echocardiography if any one of E/e' ≥14 (E/e' ≥11 for AF), tricuspid regurgitation peak velocity ≥2.8 m/s, or inferior vena cava collapsibility <50% was positive. We classified patients into grade A, grade B, and grade C according to the number of positive congestion indices. The primary endpoint was the composite of cardiovascular death and heart failure hospitalization. RESULTS During the follow-up period (median: 373 days), 162 (32%) patients experienced the primary endpoint. Grade C patients had a higher risk for the primary endpoint than grade A (HR: 2.98; 95% CI: 1.97-4.52) and grade B patients (HR: 1.92; 95% CI: 1.29-2.86) (log-rank P < 0.0001). Echocardiographic congestion grade improved the predictive value when added to the age, sex, New York Heart Association functional class, and N-terminal pro-B-type natriuretic peptide, not only in sinus rhythm (Uno C-statistic: 0.670 vs 0.655) but in AF (Uno C-statistic: 0.667 vs 0.639). CONCLUSIONS Echocardiographic congestion grade has prognostic value in patients with HFpEF with and without AF.
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Key Words
- AF, atrial fibrillation
- ASE, American Society of Echocardiography
- E/e′, ratio of early diastolic transmitral flow velocity to mitral annulus velocity
- EACVI, European Association of Cardiovascular Imaging
- HFpEF, heart failure with preserved ejection fraction
- IVC, inferior vena cava
- IVCC, inferior vena cava collapsibility
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- NYHA, New York Heart Association
- TRV, tricuspid regurgitation peak velocity
- congestion
- echocardiography
- heart failure with preserved ejection fraction
- prognosis
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Affiliation(s)
- Haruhiko Abe
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
- Address for correspondence: Dr Haruhiko Abe, Cardiovascular Division, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan. @haruhiko_abe
| | - Shumpei Kosugi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tatsuhisa Ozaki
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tsuyoshi Mishima
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Motoo Date
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaaki Uematsu
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | | | - Akito Nakagawa
- Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukihiro Koretsune
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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7
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Mouhayar EN, Hammond D, Lopez-Mattei J, Banchs J, Konopleva M, Pemmaraju N. Reversible Myocardial Edema Secondary to Tagraxofusp-Induced Capillary Leak Syndrome. JACC CardioOncol 2021; 3:752-755. [PMID: 34988487 PMCID: PMC8702795 DOI: 10.1016/j.jaccao.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Elie N Mouhayar
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Danielle Hammond
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Banchs
- Department of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Griffin JM, Rosenthal JL, Grodin JL, Maurer MS, Grogan M, Cheng RK. ATTR Amyloidosis: Current and Emerging Management Strategies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2021; 3:488-505. [PMID: 34729521 PMCID: PMC8543085 DOI: 10.1016/j.jaccao.2021.06.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is increasingly diagnosed owing to the emergence of noninvasive imaging and improved awareness. Clinical penetrance of pathogenic alleles is not complete and therefore there is a large cohort of asymptomatic transthyretin variant carriers. Screening strategies, monitoring, and treatment of subclinical ATTR-CA requires further study. Perhaps the most important translational triumph has been the development of effective therapies that have emerged from a biological understanding of ATTR-CA pathophysiology. These include recently proven strategies of transthyretin protein stabilization and silencing of transthyretin production. Data on neurohormonal blockade in ATTR-CA are limited, with the primary focus of medical therapy on judicious fluid management. Atrial fibrillation is common and requires anticoagulation owing to the propensity for thrombus formation. Although conduction disease and ventricular arrhythmias frequently occur, little is known regarding optimal management. Finally, aortic stenosis and ATTR-CA frequently coexist, and transcatheter valve replacement is the preferred treatment approach.
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Key Words
- 6MWT, 6-minute walk test
- AF, atrial fibrillation
- AL, light chain amyloid
- AS, aortic stenosis
- ASO, antisense oligonucleotide
- ATTR-CA, transthyretin cardiac amyloidosis
- ATTRv, variant transthyretin cardiac amyloidosis
- ATTRwt, wild-type transthyretin cardiac amyloidosis
- CMR, cardiac magnetic resonance
- DCCV, direct current cardioversion
- HF, heart failure
- LVEF, left ventricular ejection fraction
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- SAP, serum amyloid P component
- TAVR, transcatheter aortic valve replacement
- amyloidosis
- cardiomyopathy
- heart failure
- siRNA, small interfering RNA
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Affiliation(s)
- Jan M Griffin
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mathew S Maurer
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Richard K Cheng
- University of Washington Medical Center, Seattle, Washington, USA
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9
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Tushak ZJ, Doshi A, Trankle CR, Rao K, Cei L, Shah KB. Phenotypic Spectrum of Transthyretin Cardiac Amyloidosis in a Family: Impact of Mutation Zygosity and Sex. JACC CardioOncol 2021; 3:602-605. [PMID: 34729535 PMCID: PMC8543089 DOI: 10.1016/j.jaccao.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/15/2023] Open
Key Words
- ATTR, transthyretin amyloidosis
- CMR, cardiac magnetic resonance imaging
- HCL, heart to contralateral lung (uptake ratio for PYP scan)
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PYP, technetium-99m pyrophosphate (scan)
- SPECT, single-photon emission computed tomography
- TTE, transthoracic echocardiogram
- TTR, transthyretin
- V122I, valine substitution for isoleucine at position 122
- amyloidosis
- cardiomyopathy
- gender differences
- genetic variability
- hATTR, hereditary transthyretin amyloidosis
- heart failure
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Affiliation(s)
- Zackary J Tushak
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Amar Doshi
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Cory R Trankle
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Kris Rao
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Laura Cei
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Keyur B Shah
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
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10
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Di Filippo C, Giovannini M, Gentile S, Mori F, Porcedda G, Manfredi M, Calabri GB, De Simone L, Favilli S, Kounis NG. Kounis Syndrome Associated With Takotsubo Syndrome in an Adolescent With Peutz-Jeghers Syndrome. JACC Case Rep 2021; 3:1602-1606. [PMID: 34729510 PMCID: PMC8543138 DOI: 10.1016/j.jaccas.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 12/02/2022]
Abstract
We describe the case of a 15-year-old female patient with Peutz-Jeghers syndrome who presented with vomiting and abdominal pain secondary to ileoileal invagination. Initial analgesic treatment was not effective, and subsequent tramadol infusion resulted in clinical manifestations compatible with Kounis and Takotsubo syndromes. However, the patient had an excellent recovery. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Chiara Di Filippo
- Cardiology Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Gentile
- Cardiology Unit, Santa Maria Nuova Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Giulio Porcedda
- Cardiology Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Florence, Italy
| | | | - Luciano De Simone
- Cardiology Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Favilli
- Cardiology Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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11
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Wild MG, Gloeckler M, Wustmann KB, Erne SA, Grogg H, Huber AT, Windecker S, Praz F, Gräni C. Multimodality Imaging for Evaluation of Bicaval Valved Stent Implantation in Severe Tricuspid Regurgitation. JACC Case Rep 2021; 3:1512-1518. [PMID: 34746850 PMCID: PMC8551505 DOI: 10.1016/j.jaccas.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022]
Abstract
Preprocedural planning and postprocedural evaluation after transcatheter treatment of severe tricuspid regurgitation remain challenging and require further research and standardization. We illustrate the use of multimodality imaging techniques in 3 patients undergoing implantation of a novel custom-made bicaval valved stent for symptomatic treatment of severe tricuspid regurgitation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Mirjam G. Wild
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kerstin B. Wustmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A. Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hanna Grogg
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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12
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Mitchell JD, Cehic DA, Morgia M, Bergom C, Toohey J, Guerrero PA, Ferencik M, Kikuchi R, Carver JR, Zaha VG, Alvarez-Cardona JA, Szmit S, Daniele AJ, Lopez-Mattei J, Zhang L, Herrmann J, Nohria A, Lenihan DJ, Dent SF. Cardiovascular Manifestations From Therapeutic Radiation: A Multidisciplinary Expert Consensus Statement From the International Cardio-Oncology Society. JACC CardioOncol 2021; 3:360-380. [PMID: 34604797 PMCID: PMC8463721 DOI: 10.1016/j.jaccao.2021.06.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 01/09/2023]
Abstract
Radiation therapy is a cornerstone of cancer therapy, with >50% of patients undergoing therapeutic radiation. As a result of widespread use and improved survival, there is increasing focus on the potential long-term effects of ionizing radiation, especially cardiovascular toxicity. Radiation therapy can lead to atherosclerosis of the vasculature as well as valvular, myocardial, and pericardial dysfunction. We present a consensus statement from the International Cardio-Oncology Society based on general principles of radiotherapy delivery and cardiovascular risk assessment and risk mitigation in this population. Anatomical-based recommendations for cardiovascular management and follow-up are provided, and a priority is given to the early detection of atherosclerotic vascular disease on imaging to help guide preventive therapy. Unique management considerations in radiation-induced cardiovascular disease are also discussed. Recommendations are based on the most current literature and represent a unanimous consensus by the multidisciplinary expert panel. Radiation therapy leads to short- and long-term cardiovascular adverse effects of the vasculature and the heart, including valvular, myocardial, and pericardial disease. Computed tomography scans conducted for radiation planning or cancer staging provide an available opportunity to detect asymptomatic atherosclerosis and direct preventive therapies. Additional practical screening recommendations for cardiovascular disease based on anatomical exposure are provided. There are unique considerations in the management of radiation-induced cardiovascular disease; contemporary percutaneous treatment is often preferred over surgical options.
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Key Words
- CABG, coronary artery bypass graft
- CAC, coronary artery calcium
- CAD, coronary artery disease
- CI, confidence interval
- CT, computed tomography
- CTCA, computed tomography coronary angiography
- CV, cardiovascular
- DIBH, deep inspiratory breath hold
- HF, heart failure
- HL, Hodgkin lymphoma
- HNC, head and neck cancer
- HR, hazard ratio
- LIMA, left internal mammary artery
- MRI, magnetic resonance imaging
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- OR, odds ratio
- PAD, peripheral arterial disease
- RT, radiation therapy
- SAVR, surgical aortic valve replacement
- SVC, superior vena cava
- TAVR, transcatheter aortic valve replacement
- TTE, transthoracic echocardiogram
- aHR, adjusted hazard ratio
- cancer
- cardiovascular disease
- imaging
- prevention
- radiation therapy
- screening
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Affiliation(s)
- Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
- Address for correspondence: Dr Joshua D. Mitchell, Cardio-Oncology Center of Excellence, Washington University in St Louis, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110-1093, USA. @joshmitchellmd@Dr_Daniel_Cehic@carmenbergom@ICOSociety
| | | | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Carmen Bergom
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joanne Toohey
- Department of Radiation Oncology, GenesisCare, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Robin Kikuchi
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Joseph R. Carver
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vlad G. Zaha
- Cardiology Division, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health and Hospital System, Dallas, Texas, USA
| | - Jose A. Alvarez-Cardona
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | | | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lili Zhang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jörg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Anju Nohria
- Cardio-Oncology Program, Dana Farber Cancer Institute/Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Daniel J. Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Susan F. Dent
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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13
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Luedike P, Riebisch M, Weymann A, Ruhparwar A, Rassaf T, Mahabadi AA. Feasibility of a Novel Transcatheter Valve Repair System to Treat Tricuspid Regurgitation in ccTGA. JACC Case Rep 2021; 3:893-896. [PMID: 34317649 PMCID: PMC8311276 DOI: 10.1016/j.jaccas.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/15/2022]
Abstract
Patients with congenitally corrected transposition of the great arteries (ccTGA) with significant systemic tricuspid valve regurgitation and systemic right ventricular dysfunction have prohibitive surgical risk in adulthood. The PASCAL transcatheter valve repair system enables minimally invasive percutaneous tricuspid valve repair in the complex anatomy of patients with ccTGA. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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14
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Servato ML, Valente FX, García-Moreno LG, Casas G, Fernández-Galera R, Burcet G, Teixidó-Tura G, Calabria HC, González IF, Rodríguez-Palomares JF. Intraventricular Conundrum in a SARS-CoV-2-Positive Patient With Elevated Biomarkers of Myocardial Injury. JACC Case Rep 2021; 3:566-572. [PMID: 33821246 PMCID: PMC8011590 DOI: 10.1016/j.jaccas.2021.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
We present a case of acute myocarditis with left ventricular dysfunction and intracavitary thrombosis in a 55-year-old man with severe acute respiratory syndrome coronavirus 2 infection (coronavirus disease 2019) who was admitted with bilateral atypical pneumonia. The patient was treated with anticoagulation and optimal heart failure therapy and had an improvement of left ventricular function and thrombus resolution. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- María L. Servato
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Cardiovascular Consortium, Madrid, Spain
| | - Filipa X. Valente
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Cardiovascular Consortium, Madrid, Spain
| | - Laura Gutiérrez García-Moreno
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Cardiovascular Consortium, Madrid, Spain
| | - Guillem Casas
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Cardiovascular Consortium, Madrid, Spain
| | - Rubén Fernández-Galera
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Cardiovascular Consortium, Madrid, Spain
| | - Gemma Burcet
- Radiology Service, Institute for Diagnostic Imaging, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Gisela Teixidó-Tura
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Cardiovascular Consortium, Madrid, Spain
| | - Hug Cuéllar Calabria
- Radiology Service, Institute for Diagnostic Imaging, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Ignacio Ferreira González
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Epidemiology and Public Health Consortium, Madrid, Spain
| | - José F. Rodríguez-Palomares
- Department of Cardiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Center for Biomedical Investigation Cardiovascular Consortium, Madrid, Spain
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15
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Shaykh R, Leftin S, Suh S, Spencer R, Gorelik M, Wilson PT, Diamond R. Reversible Coronary Artery Aneurysm With Delayed Anti-inflammatory Therapy in Multisystem Inflammatory Syndrome in Children. JACC Case Rep 2021; 3:550-554. [PMID: 33649746 PMCID: PMC7904278 DOI: 10.1016/j.jaccas.2020.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023]
Abstract
A 4-year-old boy with multisystem inflammatory syndrome in children before widespread recognition of this disease developed complications, including coronary artery aneurysm, without anti-inflammatory treatment. With delayed treatment, all sequelae resolved. This case demonstrates a natural history supporting the role of anti-inflammatory treatment even with delayed or equivocal diagnosis. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Ramzi Shaykh
- NewYork-Presbyterian/Komansky Children's Hospital, New York, New York, USA
| | - Shoshana Leftin
- NewYork-Presbyterian/Komansky Children's Hospital, New York, New York, USA
| | - Sanghee Suh
- NewYork-Presbyterian/Komansky Children's Hospital, New York, New York, USA.,NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Robert Spencer
- NewYork-Presbyterian/Komansky Children's Hospital, New York, New York, USA.,NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mark Gorelik
- NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York, USA.,Columbia University Medical Center, Department of Pediatrics, New York, New York, USA
| | - Patrick T Wilson
- NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York, USA.,Columbia University Medical Center, Department of Pediatrics, New York, New York, USA
| | - Rebekah Diamond
- NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, New York, USA.,Columbia University Medical Center, Department of Pediatrics, New York, New York, USA
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16
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Vergaro G, Castiglione V, Poletti R, Buda G, Pucci A, Musetti V, Genovesi D, Aimo A, Passino C, Emdin M. Biopsy Evidence of Sequential Transthyretin and Immunoglobulin Light-Chain Cardiac Amyloidosis in the Same Patient. JACC Case Rep 2021; 3:450-454. [PMID: 34317556 PMCID: PMC8311035 DOI: 10.1016/j.jaccas.2020.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Abstract
Currently adopted diagnostic flow charts consider transthyretin and light-chain cardiac amyloidosis as mutually exclusive. Here, we report for the first time, to our knowledge, the demonstration of a biopsy-proven dual pathology in an 80-year-old man with sequential development of both wild-type transthyretin amyloidosis and light-chain cardiac amyloidosis cardiomyopathy over a 3-year timespan. (Level of Difficulty: Intermediate.).
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Key Words
- 99mTc-HMDP, 99mTc-hydroxymethylene diphosphonate
- AL amyloidosis
- AL, immunoglobulin light-chain amyloidosis
- ATTR amyloidosis
- ATTR, transthyretin amyloidosis
- CA, cardiac amyloidosis
- CMR, cardiac magnetic resonance
- HF, heart failure
- Ig, immunoglobulin
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- cardiac amyloidosis
- hs-cTnT, high-sensitivity cardiac troponin T
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Affiliation(s)
- Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | - Gabriele Buda
- Hematology Department, University of Pisa, Pisa, Italy
| | - Angela Pucci
- Histopathology Department, University of Pisa, Pisa, Italy
| | | | | | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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17
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Alvarez-Cardona JA, Zhang KW, Mitchell JD, Zaha VG, Fisch MJ, Lenihan DJ. Cardiac Biomarkers During Cancer Therapy: Practical Applications for Cardio-Oncology. JACC CardioOncol 2020; 2:791-794. [PMID: 34396295 PMCID: PMC8352269 DOI: 10.1016/j.jaccao.2020.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/16/2023]
Key Words
- BNP, B-type natriuretic peptide
- CV, cardiovascular
- ECG, electrocardiography
- EMBx, endomyocardial biopsy
- GLS, global longitudinal strain
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- LGE, late gadolinium enhancement
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NP, natriuretic peptide
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- TTE, transthoracic echocardiography
- amyloidosis
- anthracyclines
- biomarkers
- cMRI, cardiac magnetic resonance imaging
- cardiotoxicity
- chemotherapy
- detection
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Affiliation(s)
- Jose A. Alvarez-Cardona
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kathleen W. Zhang
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Vlad G. Zaha
- Division of Cardiology, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center and Advanced Imaging Research Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Michael J. Fisch
- Department of General Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel J. Lenihan
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
- Address for correspondence: Dr. Daniel J Lenihan, Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110. @ICOSociety
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18
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Miura S, Naya M, Yamashita T. Iron Deficiency Anemia-Induced Cardiomyopathy With Congestive Heart Failure: Reversible Cardiac Dysfunction Assessed by Multi-Imaging Modalities. JACC Case Rep 2020; 2:1806-1811. [PMID: 34317060 PMCID: PMC8312109 DOI: 10.1016/j.jaccas.2020.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022]
Abstract
Iron deficiency anemia (IDA) can cause left ventricular (LV) dysfunction, causing heart failure. A 48-year-old woman with severe IDA developed congestive heart failure that was properly diagnosed, managed, and followed with multiple imaging modalities to explore potential mechanisms, highlighting the reversibility of LV function in unique cardiomyopathy. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Shiro Miura
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takehiro Yamashita
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
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19
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Chowdhury M, Azari BM, Desai NR, Ahmad T. A Novel Treatment for a Rare Cause of Cardiogenic Shock. JACC Case Rep 2020; 2:1461-1465. [PMID: 34316997 PMCID: PMC8302098 DOI: 10.1016/j.jaccas.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS)–associated myocarditis is a rare but life-threatening adverse drug reaction with a very high mortality rate and no effective therapies. We report a case of DRESS-associated myocarditis complicated by cardiogenic shock successfully treated with a novel targeted therapy. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Mohsin Chowdhury
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Address for correspondence: Dr. Mohsin Chowdhury, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, Massachusetts 02215.
| | - Bani M. Azari
- Division of Cardiovascular Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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20
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Kunimasa K, Kamada R, Oka T, Oboshi M, Kimura M, Inoue T, Tamiya M, Nishikawa T, Yasui T, Shioyama W, Nishino K, Imamura F, Kumagai T, Fujita M. Cardiac Adverse Events in EGFR-Mutated Non-Small Cell Lung Cancer Treated With Osimertinib. JACC CardioOncol 2020; 2:1-10. [PMID: 34396203 PMCID: PMC8352275 DOI: 10.1016/j.jaccao.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess osimertinib-associated cardiac adverse events (AEs) in a real-world setting, using a retrospective single-center cohort study in Japan. BACKGROUND Cases of osimertinib-associated cardiac AEs have been reported but remain poorly understood. METHODS A total of 123 cases of advanced non-small cell lung cancer (NSCLC) with confirmed EGFR mutations who received osimertinib monotherapy from 2014 to 2019 at the Osaka International Cancer Institute (Osaka, Japan) were evaluated. Cardiac AEs were defined according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Changes in left ventricular ejection fraction (LVEF) and rates of cancer therapeutics-related cardiac dysfunction (CTRCD), defined as a ≥10 % absolute decline in LVEF from baseline to a value of <53%, were further assessed in 36 patients in whom serial measurements of LVEF were obtained before and during osimertinib treatment. RESULTS Severe cardiac AEs (CTCAE grade 3 or higher) occurred in 6 patients (4.9%) after osimertinib administration. These AEs included acute myocardial infarction (n = 1), heart failure with reduced LVEF (n = 3), and valvular heart disease (n = 2). Five of the 6 patients had a history of cardiovascular risk factors or disease. Myocardial biopsies in 2 of the patients showed cardiomyocyte hypertrophy and lipofuscin deposition. In 36 patients assessed with serial LVEF, LVEF declined from 69.4 ± 4.2% to 63.4 ± 10.5% with osimertinib therapy (p < 0.001). CTRCD occurred in 4 patients with a nadir LVEF of 40.3 ± 9.1% with osimertinib. CONCLUSIONS In this retrospective cohort analysis, the incidence of cardiac AEs in patients treated with osimertinib was 4.9%. Additional prospective data collected from patients with NSCLC treated with osimertinib will be important in understanding the incidence, pathophysiology, and management of cardiac AEs with osimertinib.
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Key Words
- ACE, angiotensin-converting enzyme
- AE, adverse event
- ARB, angiotensin II receptor blocker
- CTCAE, common terminology criteria for adverse event
- CTRCD, cancer therapeutics-related cardiac dysfunction
- EGFR mutations
- EGRF, epidermal growth factor receptor
- HER, human epidermal growth factor receptor
- LVEF, left ventricular ejection fraction
- LVIDd, left ventricular internal end-diastolic diameter
- LVIDs, left ventricular internal end-systolic diameter
- MR, mitral regurgitation
- NSCLC, non–small cell lung cancer
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PASP, pulmonary artery systolic pressure
- TKI, tyrosine kinase inhibitor
- TR, tricuspid regurgitation
- VEGF, vascular endothelial growth factor
- cardiac adverse events
- cardiac dysfunction
- myocardial biopsy
- non–small cell lung cancer
- osimertinib
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Affiliation(s)
- Kei Kunimasa
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Risa Kamada
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Oka
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Makiko Oboshi
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Madoka Kimura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takako Inoue
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tatsuya Nishikawa
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Taku Yasui
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Wataru Shioyama
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
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21
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Gi WT, Sedaghat-Hamedani F, Shirvani Samani O, Kayvanpour E, Herpel E, Arif R, Riffel J, Mereles D, Katus HA, Meder B. Cardiac Myxoma in a Patient With Hypertrophic Cardiomyopathy. JACC Case Rep 2020; 2:378-383. [PMID: 34317246 PMCID: PMC8311620 DOI: 10.1016/j.jaccas.2019.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 12/01/2022]
Abstract
We report a rare case of concomitant hypertrophic cardiomyopathy and cardiac myxoma without LEOPARD syndrome. Additionally, 6 similar cases were systemically reviewed, and the characteristics of this first-ever studied patient group were summarized. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Weng-Tein Gi
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Farbod Sedaghat-Hamedani
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Omid Shirvani Samani
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Elham Kayvanpour
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Esther Herpel
- Institute of Pathology Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Derliz Mereles
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Hugo A Katus
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Benjamin Meder
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany.,Department of Genetics, Stanford University, Stanford, California
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22
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Itzhaki Ben Zadok O, Ben-Avraham B, Nohria A, Orvin K, Nassar M, Iakobishvili Z, Neiman V, Goldvaser H, Kornowski R, Ben Gal T. Immune-Checkpoint Inhibitor-Induced Fulminant Myocarditis and Cardiogenic Shock. JACC CardioOncol 2019; 1:141-144. [PMID: 34396174 PMCID: PMC8352193 DOI: 10.1016/j.jaccao.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Ben-Avraham
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mithal Nassar
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zaza Iakobishvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Tel-Aviv-Jaffa District, Clalit Health Services, Tel-Aviv, Israel
| | - Victoria Neiman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Hadar Goldvaser
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Witteles RM, Liedtke M. AL Amyloidosis for the Cardiologist and Oncologist: Epidemiology, Diagnosis, and Management. JACC CardioOncol 2019; 1:117-130. [PMID: 34396169 PMCID: PMC8352106 DOI: 10.1016/j.jaccao.2019.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 02/07/2023] Open
Abstract
AL amyloidosis results from clonal production of immunoglobulin light chains, most commonly arising from a clonal plasma cell disorder. Once considered a nearly uniformly fatal disease, prognosis has improved markedly over the past 15 years, predominantly because of advances in light chain suppressive therapies. Cardiac deposition of amyloid fibrils is common, and the severity of cardiac involvement remains the primary driver of prognosis. Improvements in chemotherapy/immunotherapy have prompted a reassessment of the role of advanced cardiac therapies previously considered contraindicated in most patients, including the role of implantable cardioverter-defibrillators and cardiac transplantation. This state-of-the-art review highlights the current state of the field, including diagnosis, prognosis, and hematologic- and cardiac-specific therapies.
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Key Words
- AL amyloidosis
- ASCT, autologous stem cell transplantation
- BNP, B-type natriuretic peptide
- CyBorD, cyclophosphamide, bortezomib, and dexamethasone
- FLC, free light chain
- ICD, implantable cardioverter-defibrillator
- MGUS, monoclonal gammopathy of undetermined significance
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- SAP, serum amyloid P
- SPIE, serum protein electrophoresis with immunofixation
- UPIE, urine protein electrophoresis with immunofixation
- amyloidosis
- diagnosis
- drug therapy
- heart failure
- imaging
- treatment
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Affiliation(s)
- Ronald M. Witteles
- Division of Cardiovascular Medicine, Stanford Amyloid Center, Stanford University School of Medicine, Stanford, California, USA
| | - Michaela Liedtke
- Division of Hematology, Stanford Amyloid Center, Stanford University School of Medicine, Stanford, California, USA
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