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Nowatzke J, Guedeney P, Palaskas N, Lehmann L, Ederhy S, Cautela J, Francis S, Courand PY, Aras M, Arangalage D, Fenioux C, Finke D, Huang S, Moslehi J, Salem JE. Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis – report from an international registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Immune-checkpoint-blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis.
Methods
An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence of coronary artery disease (CAD) was defined as coronary artery stenosis >70% in patients undergoing coronary angiogram.
Results
Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary angiography, CAD was present in 59/261 (22.6%) (Table 1). Coronary revascularization was performed during the index hospitalization in 19/59 (32.2%) patients. Patients undergoing coronary revascularization less frequently received steroids administration within 24h of admission compared to the other groups (p=0.029). Myocarditis related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 5/31 (16.1%) in those not revascularized and 25/156 (16.0%) in those without CAD (p=0.001). irAE-related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 6/31 (19.4%) in those not revascularized and 31/156 (19.9%) in no CAD groups (p=0.007) (Figure 1). All-cause 90-day mortality was 11/17 (64.7%) in the revascularized cohort, compared to 13/31 (41.9%) in no revascularization and 60/158 (38.0%) in no CAD groups (p=0.10). After adjustment on age and sex, coronary revascularization remained associated with ICB-myocarditis-related death at 90 days (Hazard ratio [HR]=4.03, 95%confidence interval [CI] 1.84–8.84, p<0.001) and was marginally associated with all-cause death (HR=1.88, 95% CI 0.98–3.61, p=0.057).
Conclusion
CAD may exist concomitantly with ICB-myocarditis and portend a poorer outcome when revascularization is performed. This is potentially mediated thru delayed diagnosis and treatment or more severe presentation of ICB-myocarditis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Nowatzke
- Vanderbilt University Medical Center, Department of internal medicine , Nashville , United States of America
| | - P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - N Palaskas
- The University of Texas Medical School, Department of cardiology , Houston , United States of America
| | - L Lehmann
- University Hospital of Heidelberg, Department of cardiology , Heidelberg , Germany
| | - S Ederhy
- Hospital Saint-Antoine, Department of cardiology , Paris , France
| | - J Cautela
- Hospital Nord of Marseille, Department of cardiology , Marseille , France
| | - S Francis
- Maine Medical Center, Cardiovascular disease service line , Portland , United States of America
| | - P Y Courand
- Croix-Rousse Hospital - HCL, Fédération de cardiologie , Lyon , France
| | - M Aras
- University of California San Francisco, Division of cardiology , San Francisco , United States of America
| | - D Arangalage
- Bichat APHP Site of Paris Nord University Hospital, Department of cardiology , Paris , France
| | - C Fenioux
- Hospital Pitie-Salpetriere, Department of Pharmacology and Clinical Investigation Centre , Paris , France
| | - D Finke
- University Hospital of Heidelberg, Department of cardiology , Heidelberg , Germany
| | - S Huang
- Vanderbilt University Medical Center, Department of internal medicine , Nashville , United States of America
| | - J Moslehi
- University of California San Francisco, Division of cardiology , San Francisco , United States of America
| | - J E Salem
- Hospital Pitie-Salpetriere, Department of Pharmacology and Clinical Investigation Centre , Paris , France
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Javaid A, Monlezun D, Iliescu G, Palaskas N, Kim P, Hassan S, Lopez-Mattei J, Cilingiroglu M, Marmagiolis K, Iliescu C. Trends in hospitalized patients with cancer and stress cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Although cardiovascular disease (CVD) and cancer remain the top two causes of death worldwide, novel therapeutics have resulted in a decreased mortality rate in both groups. Accordingly, there has been a heightened awareness of patients with cancer experiencing stress cardiomyopathy (SC). In patients with cancer, the emotional stress of the diagnosis of cancer is compounded by the physical stress of treatments such as surgery, chemotherapy, immunotherapy, and radiotherapy. Previous studies have shown that SC in patients with cancer is associated with higher odds of in-hospital mortality when compared to patients with SC alone. No studies have examined the differences between patients with active cancer and SC compared to patients with active cancer without SC.
Purpose
To explore the unique impact that a diagnosis of SC has on patients with specific types of cancer, so that clinicians may recognize these phenomena and reduce morbidity associated with this disease.
Methods
We queried the 2016 United States National Inpatient Sample, which is the largest publicly available all-payer inpatient healthcare database, to identify demographic characteristics and outcomes in patients with active cancer and SC.
Results
Of 30,195,722 adult hospitalized patients, 4,719,591 (15.63%) had active cancer of whom 568,239 (12.04%) had SC. Among patients with active cancer, patients with SC versus those without SC were significantly more likely to have the following characteristics: female sex, white race, commercial insurance, hypertension, anemia, thrombocytopenia, and coagulation disorder (p<0.003 for all variables). The five most common primary malignancies in patients with SC were breast (13.4%), lung (10.2%), skin (9.5%), colon (8.1%), and leukemia (4.8%) (Figure 1).
In machine learning-augmented propensity score-adjusted multivariable regression fully adjusting for age, race, income, and presence of metastases, the only primary malignancies that significantly increased the likelihood of SC were lung cancer (OR 1.25; p=0.003) and breast cancer (OR 1.81; p<0.001) (Table 1). In separate regression, neither SC alone nor having both SC and cancer was significantly associated with mortality. The presence of concomitant SC and breast cancer was significantly associated with reduced mortality (OR 0.48; p=0.032).
Conclusion
In patients with active cancer, SC was not associated with in-hospital mortality. In addition, patients with both SC and breast cancer had significantly reduced mortality when compared to all patients with cancer. Further investigation will be necessary to confirm these findings and determine the possible protective factors in patients with SC and breast cancer. Furthermore, clinicians should be aware, early during hospitalization, of the increased likelihood of SC in patients with lung cancer and breast cancer, in order to reduce morbidity associated with these diagnoses.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Javaid
- University of Nevada, Las Vegas School of Medicine, Internal Medicine, Las Vegas, United States of America
| | - D Monlezun
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - G Iliescu
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - N Palaskas
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - P Kim
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - S Hassan
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - J Lopez-Mattei
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - M Cilingiroglu
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - K Marmagiolis
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
| | - C Iliescu
- University of Texas MD Anderson Cancer Centre, Cardiology, Houston, United States of America
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Steiner R, Banchs J, Koutroumpakis E, Becnel M, Gutierrez C, Strati P, Pinnix C, Feng L, Claussen C, Palaskas N, Karimzad K, Ahmed S, Neelapu S, Shpall E, Wang M, Vega F, Westin J, Nastoupil L, Deswal A. CARDIOVASCULAR EVENTS AMONG ADULT PATIENTS WITH AGGRESSIVE B‐CELL LYMPHOMA TREATED WITH STANDARD OF CARE AXICABTAGENE CILOLEUCEL AND TISAGENLECLEUCEL. Hematol Oncol 2021. [DOI: 10.1002/hon.177_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- R. Steiner
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - J. Banchs
- MD Anderson Cancer Center Cardiology Houston USA
| | | | - M. Becnel
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - C. Gutierrez
- MD Anderson Cancer Center Critical Care & Respiratory Care Houston Texas USA
| | - P. Strati
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - C. Pinnix
- MD Anderson Cancer Center Radiation Oncology Houston Texas USA
| | - L. Feng
- MD Anderson Cancer Center Biostatistics Houston Texas USA
| | - C. Claussen
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - N. Palaskas
- MD Anderson Cancer Center Cardiology Houston USA
| | - K. Karimzad
- MD Anderson Cancer Center Cardiology Houston USA
| | - S. Ahmed
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - S. Neelapu
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - E. Shpall
- MD Anderson Cancer Center Stem Cell Transplantation Houston Texas USA
| | - M. Wang
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - F. Vega
- MD Anderson Cancer Center Hematopathology Houston Texas USA
| | - J. Westin
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - L. Nastoupil
- MD Anderson Cancer Center Lymphoma & Myeloma Houston Texas USA
| | - A. Deswal
- MD Anderson Cancer Center Cardiology Houston USA
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Aldrich J, Pundole X, Tummala S, Andersen C, Abdel-Wahab N, Palaskas N, Deswal A, Suarez-Almazor M. THU0336 IMMUNE CHECKPOINT INHIBITOR-RELATED MYOSITIS: A RETROSPECTIVE COHORT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Myositis is a rare immune checkpoint inhibitor (ICI)-related adverse event frequently associated with myasthenia gravis (MG) and myocarditis (MC) leading to mortality rates up to 52%.1Objectives:To characterize the presentation, course and outcomes of patients with ICI-related myositis alone or with overlap syndrome (myositis with MG or MC or both).Methods:We retrospectively identified a cohort of patients treated with ICI at MD Anderson Cancer Center between 2016 and 2019. Suspected myositis was identified using International Classification of Disease version 10 codes and confirmed by electronic medical record review of muscle enzymes, pathology, and other tests, when available. Patients with myositis alone or with overlap syndrome were compared using Fischer’s exact tests and t tests.Results:During the study period 8,636 patients received ICI, of which 31 (0.36%) were diagnosed with myositis: 14 (45%) with myositis alone and 17 (55%) with overlap (MG in 5, MC in 4, MG and MC in 8). Twenty patients received programmed death-1 (PD-1) or programmed death-ligand-1 (PDL-1) inhibitors, and 10 received combination PD-1/PDL-1 inhibitor with a cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) inhibitor. One patient received single agent CTLA-4 inhibitor (excluded from pooled data). For the entire cohort the median age at diagnosis was 69 years (range: 40-95 years); the most common presenting symptoms were fatigue in 27 (90%) patients, weakness in 24 (80%), and myalgia in 23 (77%); median CK was 2,236 U/L (range: 23-19,794 U/L). For treatment, 22 of 30 (73%) patients received at least one therapy in addition to steroids: plasmapheresis in 15 (50%) patients, intravenous immune globulin (IVIG) in 12 (40%), biologics in 9 (30%) (rituximab in 6, infliximab in 5, tocilizumab in 3), tacrolimus in 6 (20%), and mycophenolate mofetil in 4 (13%). Median length of exposure to steroids was 47 days (range: 1-250 days). Five (17%) patients were rechallenged with ICI after myositis resolution (3 with myositis alone, 2 with overlap), of which 1 (20%) patient experienced a myositis flare. Twenty-five (83%) patients were not rechallenged on ICI and 3 (12%) of those patients had a flare. Differences between patients with myositis alone compared to those with overlap are shown in Table 1. Patients with overlap more often received a second therapy, specifically plasmapheresis and IVIG, had longer hospitalizations and greater symptom burden at discharge. Overall death between groups was similar; however death attributed to the adverse event occurred only in those with overlap.Table 1.Myositis alone vs. OverlapMyositis alone(N=13)Overlap(N=17)PvalueN(%)/median days [range]Time to symptom onset42 [10-161]22 [9-149]0.234Initial steroid dose (mg/kg day)1.71.80.187Second therapy7 (54)15 (88)0.049 Plasmapheresis3 (23)12 (71)0.025 IVIG1 (8)11 (65)0.002Outcomes Hospitalization length5 [2-50]24 [7-92]0.019 Respiratory failure0 (0)13 (76) Symptoms at discharge0.047 Improved8 (62)6 (35) Resolved3 (23)1 (6)Death Overall8 (62)12 (71)0.706 Adverse event0 (0)7 (41)Conclusion:Our results represent the largest cohort of ICI-related myositis to date. Patients with overlap syndrome are treated more aggressively and have worse outcomes than those with myositis alone. Prospective studies are warranted to determine risk factors for developing myositis or overlap syndrome and to determine optimal treatment.References:[1]Anquetil BC, Salem LJ-E, Lebrun-Vignes JB, et al. Immune Checkpoint Inhibitor–Associated Myositis: Expanding the Spectrum of Cardiac Complications of the Immunotherapy Revolution.Circulation. 2018;138(7):743-745.Disclosure of Interests:None declared
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Lee M, Gill C, Serauto Canache A, Donisan T, Balanescu D, Marah N, Stone D, Stone J, Boone D, Cervoni Curet F, Agha A, Iliescu C, Palaskas N. P678Pericardiocentesis in thrombocytopenic cancer patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pericardial effusion is a known complication in cancer patients, resulting in chest pain, cardiac tamponade, and cardiogenic shock. Although technological advances allow for early detection, treatment options are limited for those also suffering from thrombocytopenia.
Purpose
Our study aims to evaluate survivorship of thrombocytopenic cancer patients who underwent pericardiocentesis.
Methods
From 2008 to 2019, we assessed overall mortality and follow-up post-pericardiocentesis in cancer patients with concurrent thrombocytopenia (<150,000 cells/microliter) at our cancer center. Thrombocytopenia grading was determined on the procedure day via serology platelet cell count with the following thresholds: Grade 1 (<50x103 cells/mL), Grade 2 (51–100x103 cells/mL), and Grade 3 (101–149x103 cells/mL).
Results
In 137 patients, we identified 65 (47%) patients with Grade 1, 30 (22%) with Grade 2, and 42 (31%) with Grade 3 thrombocytopenia. The calculated platelet count average was 66x103 cells/mL, median was 59x103 cells/mL, and range was 6 to 147x103 cells/mL. Of note, 7 (5%) patients had platelets <10x103 cells/mL. One patient developed a hematoma at the percutaneous site of pericardial drain, no other complications were noted. Kaplan Meier survival analysis by log-rank (mantel-cox) showed statistical significance (p=0.025). Comparatively, the cumulative survival of patients at 30 days was 63% in Grade 1, 67% in Grade 2, and 83% in Grade 3 patients. At one year, it was 26% in Grade 1, 37% in Grade 2, and 48% in Grade 3 patients.
Conclusion
Pericardiocentesis offers rapid symptomatic relief and can be life-saving in cardiac tamponade. In cancer patients, the development of pericardial effusions and thrombocytopenia increases due to the underlying malignancy and cancer therapeutics. Although thrombocytopenia is thought to increase peri-procedural risks, in this cohort there was only one minor complication and this occurred in Grade 2 thrombocytopenia. For thrombocytopenic cancer patients suffering from large pericardial effusions, high pre-operative risk scores often exclude them from receiving surgical pericardial windows. Although mortality was higher in severe thrombocytopenia, this is likely due to the competing risk of more severe cancer; there were no complications with Grade 1 thrombocytopenia. Especially noteworthy, no complications in those with platelets <10,000 cells/uL. Our study shows that in this population of patients, pericardiocentesis is a feasible intervention with low complication rate to help improve quality of life and potentially life-saving treatment.
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Affiliation(s)
- M Lee
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - C Gill
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - A Serauto Canache
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - T Donisan
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Balanescu
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - N Marah
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Stone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - J Stone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Boone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - F Cervoni Curet
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - A Agha
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - C Iliescu
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - N Palaskas
- University of Texas MD Anderson Cancer Center, Houston, United States of America
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Balanescu DV, Donisan T, Lee M, Tran P, De Sirkar S, Palaskas N, Lopez-Mattei J, Kim PY, Iliescu G, Balanescu SM, Marmagkiolis K, Iliescu C. P3629Invasive versus medical management of non-ST elevation myocardial infarction in cancer patients: knowledge is bliss. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cancer patients with non-ST elevation myocardial infarction (NSTEMI) frequently present with comorbidities (e.g., anaemia, thrombocytopenia) that discourage invasive treatment.
Purpose
To compare outcomes of cancer patients with NSTEMI treated with optimal medical therapy (OMT) + percutaneous coronary intervention (PCI) versus OMT alone and to identify variables associated with overall survival (OS).
Methods
All cancer patients diagnosed with NSTEMI between March 2016 and December 2018 at our institution were included. Patients were classified based on treatment of NSTEMI into 2 groups: invasive strategy or OMT alone. The invasive group was further classified into early (PCI≤72 hours since presentation) or delayed strategy (PCI>72 hours). Clinical and laboratory data, oncologic history, major adverse cardiovascular events, and survival were collected. Univariate Cox proportional hazards regression analyses were conducted to identify variables associated with OS.
Results
We included 201 patients with a mean age of 68±11 years, 136 (68%) of which were women. Median OS was 13 months. Factors influencing OS are presented in Table I. Patients receiving PCI had better OS compared to patients treated with OMT only (Figure 1, p<0.0001). Procedure-related complications were non-fatal and present in 2 (1.85%) cases.
Table I Covariate Hazard Ratio (95% confidence interval) p-value Early invasive treatment (≤72 hours) 0.327 (0.207–0.516) <0.0001 Delayed invasive treatment (>72 hours) 0.496 (0.252–0.977) 0.0426 Presenting symptom: chest pain 0.406 (0.254–0.649) 0.0002 Presenting symptom: others 1.869 (1.223–2.855) 0.0039 Single agent antiplatelet therapy 0.434 (0.263–0.716) 0.0011 Dual agent antiplatelet therapy 0.294 (0.174–0.496) <0.0001 Statins 0.440 (0.276–0.703) 0.0006 Active cancer 4.487 (1.646–12.234) 0.0033 Prior chemotherapy 2.312 (1.328–4.023) 0.0030 Prior chest radiation 1.752 (1.065–2.884) 0.0272 Active chemotherapy 1.931 (1.271–2.934) 0.0021
Figure 1
Conclusions
An invasive management of NSTEMI in cancer patients, especially within 72 hours, appears to be associated with improved OS. Patients presenting with symptoms other than chest pain were less likely to undergo PCI and had worse outcomes. Active cancer, a history of chest radiation, and active or prior chemotherapy were also associated with decreased OS.
Acknowledgement/Funding
None
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Affiliation(s)
- D V Balanescu
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - T Donisan
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - M Lee
- McGovern Medical School at The University of Texas Health Science Center at Houston, Internal Medicine, Houston, United States of America
| | - P Tran
- Baylor College of Medicine, Houston, United States of America
| | - S De Sirkar
- McGovern Medical School at The University of Texas Health Science Center at Houston, Internal Medicine, Houston, United States of America
| | - N Palaskas
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - J Lopez-Mattei
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - P Y Kim
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - G Iliescu
- University of Texas MD Anderson Cancer Center, General Internal Medicine, Houston, United States of America
| | - S M Balanescu
- Elias Emergency Universitary Hospital, Cardiology, Bucharest, Romania
| | | | - C Iliescu
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
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Balanescu DV, Liu VY, Donisan T, Agha AM, Lopez-Mattei JC, Giza DE, Iliescu GD, Palaskas N, Kim PY, Boone DL, Yang EH, Herrmann J, Marmagkiolis K, Angelini P, Iliescu CA. P1253Clinical features and outcomes of patients with chemotherapy-induced Takotsubo stress cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D V Balanescu
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - V Y Liu
- McGovern Medical School at The University of Texas Health Science Center at Houston, Internal Medicine, Houston, United States of America
| | - T Donisan
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - A M Agha
- McGovern Medical School at The University of Texas Health Science Center at Houston, Internal Medicine, Houston, United States of America
| | - J C Lopez-Mattei
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - D E Giza
- McGovern Medical School at The University of Texas Health Science Center at Houston, Family and Community Medicine, Houston, United States of America
| | - G D Iliescu
- The University of Texas MD Anderson Cancer Center, General Internal Medicine, Houston, United States of America
| | - N Palaskas
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - P Y Kim
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - D L Boone
- McGovern Medical School at The University of Texas Health Science Center at Houston, Internal Medicine, Houston, United States of America
| | - E H Yang
- University of California Los Angeles, Medicine, Los Angeles, United States of America
| | - J Herrmann
- Mayo Clinic, Cardiovascular Disease, Rochester, United States of America
| | | | - P Angelini
- Texas Heart Institute, Cardiology, Houston, United States of America
| | - C A Iliescu
- The University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
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