Anthracyclines: The Double Edged Sword
Format
Poster
Start Date
6-11-2020 12:15 PM
End Date
6-11-2020 12:30 PM
Abstract
Anthracyclines: The Double Edged Sword Joel Brooks Tamayo Joel, MD, Internal Medicine, Kendall Regional Medical Center. Daniel Gonzalez, MD, Internal Medicine, Kendall Regional Medical Center. Luis Caraballo, MD, Internal Medicine, Kendall Regional Medical Center. Ruben Cabrera, MD, Internal Medicine, Kendall Regional Medical Center. Karina Diaz, MD, faculty. Jose Gascon, MD, Program Director Introduction Anthracycline-induced cardiomyopathy (AIC) is a disease spectrum ranging from development of overt heart failure to asymptomatic dysfunction in left ventricular ejection fraction (LVEF). Case presentation This is a 64-year-old male with past medical history significant for Non-Hodgkin lymphoma on CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone presented to the ER c/o dyspnea and orthopnea. Absent chest pain, palpitations or leg swelling. On arrival he was in acute respiratory failure and placed on Bipap. 2D-Echo prior starting chemotherapy reported a normal LVEF (70%). EKG: HR 119 bpm, normal sinus rhythm. No ST/T changes. Labs: Elevated serial troponin I and NT pro BNP. Echocardiogram: Moderately to severely reduced LVEF 35%. Chest CT: Moderate right and small left pleural effusions Discussion There is not consensus about how to monitor AIC but monitoring the LVEF remains the basis for identifying cardiotoxicity, baseline measurements and continuous surveillance for patients receiving a cumulative dosage > 200 mg/m2 is of paramount importance. Cardiac troponin and NT pro BNP are also indicators of cardiotoxicity with a 93% sensitivity and 91% negative predictive value for future cardiotoxicity. Institution of beta-blocker and ACE inhibitors in combination are associated with greater chances of LVEF recovery. Conclusion Anthracyclines remain the cornerstone of chemotherapeutic regimens for a variety of cancers but their use is limited by dose-dependent cardiotoxicity. Understanding the biological mechanisms underlying AIC is critical to developing successful strategies for early detection, and treatment. The purpose of this case report is to raise awareness about surveillance, early diagnosis and management of AIC. Key words: Anthracyclines, cardiotoxicity, cardiomyopathy.
Anthracyclines: The Double Edged Sword
Anthracyclines: The Double Edged Sword Joel Brooks Tamayo Joel, MD, Internal Medicine, Kendall Regional Medical Center. Daniel Gonzalez, MD, Internal Medicine, Kendall Regional Medical Center. Luis Caraballo, MD, Internal Medicine, Kendall Regional Medical Center. Ruben Cabrera, MD, Internal Medicine, Kendall Regional Medical Center. Karina Diaz, MD, faculty. Jose Gascon, MD, Program Director Introduction Anthracycline-induced cardiomyopathy (AIC) is a disease spectrum ranging from development of overt heart failure to asymptomatic dysfunction in left ventricular ejection fraction (LVEF). Case presentation This is a 64-year-old male with past medical history significant for Non-Hodgkin lymphoma on CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone presented to the ER c/o dyspnea and orthopnea. Absent chest pain, palpitations or leg swelling. On arrival he was in acute respiratory failure and placed on Bipap. 2D-Echo prior starting chemotherapy reported a normal LVEF (70%). EKG: HR 119 bpm, normal sinus rhythm. No ST/T changes. Labs: Elevated serial troponin I and NT pro BNP. Echocardiogram: Moderately to severely reduced LVEF 35%. Chest CT: Moderate right and small left pleural effusions Discussion There is not consensus about how to monitor AIC but monitoring the LVEF remains the basis for identifying cardiotoxicity, baseline measurements and continuous surveillance for patients receiving a cumulative dosage > 200 mg/m2 is of paramount importance. Cardiac troponin and NT pro BNP are also indicators of cardiotoxicity with a 93% sensitivity and 91% negative predictive value for future cardiotoxicity. Institution of beta-blocker and ACE inhibitors in combination are associated with greater chances of LVEF recovery. Conclusion Anthracyclines remain the cornerstone of chemotherapeutic regimens for a variety of cancers but their use is limited by dose-dependent cardiotoxicity. Understanding the biological mechanisms underlying AIC is critical to developing successful strategies for early detection, and treatment. The purpose of this case report is to raise awareness about surveillance, early diagnosis and management of AIC. Key words: Anthracyclines, cardiotoxicity, cardiomyopathy.