P710 Nivolumab-induced takotsubo syndrome: a case report
| Autor: | R M Tenaglia, C Paolini, C Bilato, Giulia Dolci, Francesca Prevedello, I Lobascio |
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| Rok vydání: | 2020 |
| Předmět: | |
| Zdroj: | European Heart Journal - Cardiovascular Imaging. 21 |
| ISSN: | 2047-2412 2047-2404 |
| DOI: | 10.1093/ehjci/jez319.383 |
| Popis: | Background Nivolumab is a monoclonal antibody targeting programmed cell death protein 1 (PD-1), with a demonstrated clinical efficacy against metastatic cancer. Immunotherapy cardiovascular toxicity is rare, but recent scientific literature demonstrated possible and different cardiovascular side effects. Nivolumab was found to be associated with fatal acute myocarditis with diffuse myocardial necrosis and heart failure. To our knowledge no case of Nivolumab induced Tako-tsubo syndrome has ever been reported. Case presentation A 76-year-old woman was admitted to the emergency department for dyspnoea with electrocardiographic evidence of extensive anterior ST segment elevation (Figure 1A); the patient was hemodynamically unstable with increasing shortness of breath and oxygen desaturation (arterial blood pressure 90/50 mmHg, heart rate 120 beats/min, O2 Sat. 87%). She was scheduled for urgent coronary angiography which eventually demonstrated no significant coronary artery disease. The ventriculography revealed dyskinesis of the left apex and peri-apical segments and basal hyperkinesis (Figure 1B). The final diagnosis was stress cardiomyopathy or Tako-tsubo syndrome. The echocardiogram performed in the acute setting revealed severe left ventricular impairment (ejection fraction, EF = 30%) confirming the typical apical ballooning pattern of the syndrome (Figure 1C). Left ventricular outflow tract obstruction was not found. At admission, the level of TroponinT was mildly elevated (745 ng/L) and NT-proBNP was 35 000 pg/ml. The patient was treated with optimal heart failure medical therapy with gradual and complete left ventricular function recovery (EF at discharge = 55%). Of note, the patient had a history of primary lung adenocarcinoma firstly treated in 2017 with carboplatin; due to cancer progression she had undergone Nivolumab therapy in October 2018 with a total of three cycles, the last one interrupted one month before the cardiovascular event due to ipokaliemia and mild renal impairment. At that time the patient was defined as having a good functional status. Apart from the oncologic treatment, patient’s history did not reveal any "acute" stressful event. Conclusions To the best of our knowledge this is the first Takotsubo cardiomyopathy ever detected after Nivolumab therapy. Stress cardiomyopathy is a rare but possibly severe complication that could appear in the course of oncological treatment and, in this backdrop, its aetiology is not well understood. As a matter of fact, cardiac function monitoring and strict clinical follow-up for early detection of complications is mandatory in these patients. Favourable outcomes may be achieved with early diagnosis and prompt treatment introduction. Abstract P710 Figure. Diagnostic evaluation of Takotsubo Sdr |
| Databáze: | OpenAIRE |
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