Author + information
- Dana Giza,
- Juan Lopez-Mattei,
- Peter Kim,
- Ezequiel D. Muñoz Gonzalez,
- Joerg Herrmann,
- Gloria Iliescu,
- Eric Yang,
- Saamir Hassan and
- Cezar Iliescu
Background: Chemotherapy induced stress cardiomiopathy (SC) is linked to antineoplastic agents associated with abnormal vasoreactivity, endothelial damage and arterial thrombosis. We aimed to assess the impact of SC on cancer therapy and the overall survival in patients with SC triggered by chemotherapy.
Methods: All cancer patients who fulfilled the diagnostic criteria for SC over a 6-year period were included in the study. Five patients had chemotherapy triggered SC (four female, 1 men, mean age 67.6 ± 3.53 years). Clinical presentation, ECG, laboratory data, transthoracic echocardiogram results were registered during acute phase and follow up for 12 months. Data on complications during SC event, including LV thrombus, cardiac arrhythmias, respiratory failure and cardiac/non-cardiac death was collected.
Results: Out of 30 patients who fulfilled the diagnostic criteria for SC and underwent coronary angiography, 5 patients (16.6%) had SC triggered by chemotherapy. All patients underwent chemotherapy for solid tumors with Paclitaxel (3 patients), 5-FU (1 patient), and Bevacizumab (1 patient). Clinical presentation included chest pain (80%) and hypotension (20%). T wave inversion was the most common electrocardiographic presentation (60%), followed by ST elevation (20%) and sinus tachycardia (20%). All patients had changes of the cardiac biomarkers (BNP mean 1704 pg/dl, TN I mean 1.93 ng/dl, CK-MB mean 11 ng/dl) and significant LV dysfunction (LVEF <50% in 60% of the cases). Apical ballooning pattern was identified in 80% of the cases. Aspirin and beta blockers were initiated in all patients. 80% of the patients were able to resume chemotherapy after a median time of 20 days after SC. None of the patients experienced recurrence of SC.
Conclusions: SC should be considered in the differential diagnosis of cancer patients undergoing chemotherapy and present with acute coronary syndrome. Special attention for SC occurrence is required for patients undergoing chemotherapy with Paclitaxel. Chemotherapy induced SC is associated with good short-term prognosis while on supportive cardiac therapy, therefore chemotherapy can be restarted as soon as the systolic function recovers.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-293
- 2017 American College of Cardiology Foundation