Gregory Hartlage

Trastuzumab-induced cardiomyopathy: not as benign as it looks? A retrospective study.

BACKGROUND One of the recent advances in the treatment of breast cancer is trastuzumab. However, a major side effect of this medication is cardiomyopathy. Our objective was to determine the incidence of trastuzumab-induced cardiomyopathy and the rate of discontinuation of trastuzumab in a clinical setting. METHODS AND RESULTS We retrospectively reviewed the records of all women treated with trastuzumab at the Moffitt Cancer Center between 2003 and 2007. Cardiomyopathy was defined as symptomatic heart failure or a decrease of ejection fraction by >or=10% from baseline or to <50%. Statistical analysis was done with Fisher exact test, t-test test, and Wilcoxon signed rank test. Cardiomyopathy developed in 52 of 156 (33.3%) of patients being treated with trastuzumab. In the adjuvant group, 23 (19.5%) of women permanently or temporarily discontinued therapy secondary to cardiomyopathy. CONCLUSIONS Cardiomyopathy is a common side effect of trastuzumab that leads to discontinuation of treatment in a significant proportion of patients. Further studies are indicated to establish the ways to predict, prevent, and treat cardiomyopathy to provide patients with maximal therapeutic benefit of trastuzumab.

Cardio-Oncology Training: A Proposal From the International Cardioncology Society and Canadian Cardiac Oncology Network for a New Multidisciplinary Specialty

There is an increasing awareness and clinical interest in cardiac safety during cancer therapy as well as in optimally addressing cardiac issues in cancer survivors. Although there is an emerging expertise in this area, known as cardio-oncology, there is a lack of organization in the essential components of contemporary training. This proposal, an international consensus statement organized by the International Cardioncology Society and the Canadian Cardiac Oncology Network, attempts to marshal the important ongoing efforts for training the next generation of cardio-oncologists. The necessary elements are outlined, including the expectations for exposure necessary to develop adequate training. There should also be a commitment to local, regional, and international education and research in cardio-oncology as a requirement for advancement in the field.

Developing a comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center experience

Cardio-oncology is a multidisciplinary field focusing on the management and prevention of cardiovascular complications in cancer patients and survivors. While the initial focus of this specialty was on heart failure associated with anthracycline use, novel anticancer agents are increasingly utilized and are associated with many other cardiotoxicities including hypertension, arrhythmias and vascular disease. Since its inception, the field has developed at a rapid pace with the establishment of programs at many major academic institutions and community practices. Given the complexities of this patient population, it is important for providers to possess knowledge of not only cardiovascular disease but also cancer subtypes and their specific therapeutics. Developing a cardio-oncology program at a stand-alone cancer center can present unique opportunities and challenges when compared to those affiliated with other institutions including resource allocation, cardiovascular testing availability and provider education. In this review, we present our experiences establishing the cardio-oncology program at Moffitt Cancer Center and provide guidance to those individuals interested in developing a program at a similar independent cancer institution.

Transapical Closure of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare but serious sequela of endocarditis or valve replacement surgery. Because open-heart surgery is a high-risk treatment option, alternative methods are sought. We present the case of a 77-year-old man with a noninfected mechanical mitral valve whose pseudoaneurysm was repaired by introducing an occluder device into the defect by a transapical approach. Upon follow-up imaging, the defect was successfully closed. We conclude that percutaneous closure of pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a viable alternative to surgery and that a transapical approach is an appropriate method of access.

Mitral regurgitation after anthracycline exposure: a case report

We report the case of a 66-year-old African American female with a history of breast cancer previously treated with anthracycline based chemotherapy presenting with significant mitral regurgitation. She initially had preserved left ventricular systolic function with normal cardiac chamber dimensions, however, she developed progressive left ventricular chamber dilation and mild reduction in systolic function, which prompted surgical correction of her mitral regurgitation. After surgical mitral valve repair, she developed overt left ventricular failure with severe systolic dysfunction; however, she responded well to subsequent medical therapy.

U-SHAPED CONTRACTION PATTERN DERIVED BY CARDIOVASCULAR MAGNETIC RESONANCE PREDICTS CARDIAC RESYNCHRONIZATION THERAPY RESPONSE IN PATIENTS WITH NON-CLASSIC ELECTROCARDIOGRAM PATTERNS

Patients undergoing cardiac resynchronization therapy (CRT) have higher response rates if they have typical left bundle branch block (LBBB) with QRS durations of >150ms. However, the benefits of CRT are less certain in those with wide QRS without classic LBBB or in those with QRS duration <150ms.

Internal Jugular Venous Pseudoaneurysm in a Patient with Heart Failure and Severe Tricuspid Regurgitation.

The differential diagnosis of a lateral neck mass includes a number of possible etiologies. While jugular venous aneurysms and pseudoaneurysms are rare entities, they should be considered in the differential diagnosis of a pulsatile lateral neck mass. We present a case of an idiopathic jugular venous pseudoaneurysm and its association with worsening tricuspid regurgitation in a patient with heart failure with preserved ejection fraction.

Diagnosis Using CCTA and Management of Anomalous Right Coronary Artery from the Opposite Sinus

Coronary anomalies can be observed in 1–1.2% of all angiograms performed. Majority of coronary anomalies are benign and do not lead to cardiac ischemia; however anomalous coronary arteries from the opposite sinus (ACAOS) are often associated with sudden cardiac deaths, typically in 0.11–0.35% of individuals who participate in vigorous physical activity (Peñalver et al., 2012). Left and right ACAOS have an incidence of 0.15% and 0.92%, respectively. Left ACAOS are often associated with higher incidence of sudden cardiac death; this could be secondary to greater territory of myocardial perfusion by the left coronary artery. ACAOS are often asymptomatic and initially present as sudden death following exertion in young athletes. The management of left ACAOS is clear and surgery is usually indicated. However there is a lack of consensus on the management of certain cases of right ACAOS. In this paper a case of 20 yo M with right coronary artery from left sinus is going to be presented with a discussion on pathophysiology, diagnosis, and management.

DOBUTAMINE STRESS ECHOCARDIOGRAPHY RISK-STRATIFIES WOMEN WITH LOW-GRADIENT AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

Patients with severe aortic stenosis and low mean transvalvular gradient have poor outcomes, with an estimated 30 day post-surgical Aortic Valve Replacement (AVR) mortality of 21%. Low Dose Dobutamine Stress Echocardiography (LD-DSE) is performed in these patients for further risk stratification by

Association of Epicardial Adipose Tissue With Cardiometabolic Risk and Metabolic Syndrome in Patients With Rheumatoid Arthritis: EAT and Cardiometabolic Risk in RA

Patients with rheumatoid arthritis (RA) have increased coronary atherosclerosis possibly related to increased prevalence of visceral adiposity, insulin resistance, and metabolic syndrome. Epicardial adipose tissue (EAT), a type of visceral fat, may contribute to cardiometabolic risk. The aim of this study was to measure EAT volume in patients with RA and determine its relationship with cardiometabolic risk markers and coronary artery calcium.