Citations

This cohort study examines the association of bruton tyrosine kinase inhibitor therapy in B-cell malignant disease with increased risk of pericardial effusion and cardiovascular outcomes.

Background Immune‐checkpoint inhibitors (ICI) are associated with adverse cardiac events. Although troponin elevation is a diagnostic criterion for ICI‐related myocarditis (ICIrM) and myocardial infarction, data on other causes of troponin elevation and their outcomes in ICI‐treated patients are limited. Methods All patients treated with ICI who had hs‐TnT (high‐sensitivity troponin T) measured at a multicenter institution from 2011 to 2022 were included. Clinical data, outcomes (cardiac death, heart failure (HF), major adverse cardiovascular events [myocardial infarction, stroke, heart failure]), and cause of hs‐TnT elevation were assessed. Risks of cardiac events were compared across hs‐TnT elevation causes. Results Of 5423 patients treated with ICI, 1669 had post‐ICI hs‐TnT measurement (mean age 68.7±11.3 years, 58.3% male), with 1‐year follow‐up. Hs‐TnT elevation in patients with ICIrM (n=59) was associated with the highest risk for cardiac death (hazard ratio [HR], 52.7 [95% CI, 11.7–238.0], P <0.001), followed by hs‐TnT elevation due to heart failure (HR, 15.9), myocardial infarction/type 2 ischemia (HR, 11.6), and infection/sepsis (HR, 5.7), compared with those with no hs‐TnT elevation. ICIrM also carried highest risk for major adverse cardiovascular events (HR, 8.2, [95% CI, 4.4–15.3], P <0.001), followed by myocardial infarction/type 2 ischemia (HR, 8.1), heart failure (HR, 7.6), pulmonary embolus (HR, 5.1), infection/sepsis (HR, 4.1), and indeterminate cause (HR, 2.4). Among ICIrM, HsTnT value >576 ng/L best predicted risk for cardiac death and >319 ng/L for major adverse cardiovascular events. Conclusions Hs‐TnT elevation after ICI therapy is associated with increased risk of cardiac events, particularly in ICIrM, and a graded prognostic association depending on the cause of hs‐TnT elevation. Identifying the underlying cause and troponin thresholds may guide risk stratification and management.

Abstract Background Fabry’s disease, an X-linked lysosomal storage disorder, shares cardiac manifestations with hypertrophic cardiomyopathy (HCM). We underscore the importance of considering Fabry’s disease as a differential diagnosis in HCM patients, highlighting genetic testing’s role in cardiomyopathy evaluation. Case summary Three male patients with left ventricular hypertrophy were initially diagnosed with HCM but were later found to have Fabry’s disease through genetic testing. Atypical features such as renal dysfunction and conduction abnormalities raised suspicion. Genetic testing confirmed diagnosis, guiding tailored management. Discussion Fabry’s disease poses diagnostic challenges due to its resemblance to HCM. Genetic testing enables precise diagnosis and personalized management, especially in cases with atypical presentations. Early recognition and intervention, facilitated by genetic testing, can improve patient outcomes in Fabry’s disease.

The long-term survivorship of patients diagnosed with cancer has improved due to accelerated detection and rapidly evolving cancer treatment strategies. As such, the evaluation and management of cancer therapy related complications has become increasingly important, including cardiovascular complications. These have been captured under the umbrella term “cardiotoxicity” and include left ventricular dysfunction and heart failure, acute coronary syndromes, valvular abnormalities, pericardial disease, arrhythmia, myocarditis, and vascular complications. These complications add to the burden of cardiovascular disease (CVD) or are risk factors patients with cancer treatment are presenting with. Of note, both pre- and newly developing CVD is of prognostic significance, not only from a cardiovascular perspective but also overall, potentially impacting the level of cancer therapy that is possible. Currently, there are varying recommendations and practices regarding CVD risk assessment and mitigating strategies throughout the cancer continuum. This article provides an overview on this topic, in particular, the role of cardiac imaging in the care of the patient with cancer. Furthermore, it summarizes the current evidence on the spectrum, prevention, and management of chemotherapy-related adverse cardiac effects.

Introduction: Constrictive pericarditis (CP) can lead to cardiac dysfunction and a range of clinical symptoms. However, differentiating it from conditions like restrictive cardiomyopathy can be challenging due to the overlapping features. Case Presentation: We present a case of a 61-year-old female with a history of atrial flutter and subsequent atrial fibrillation, experiencing worsening dyspnea on exertion, lip cyanosis, and upper abdominal constriction. Extensive diagnostic workup, including Echo, CT scan, and cardiac MRI, revealed severe biatrial enlargement, ventricular interdependence, elevated filling pressures, reduced cardiac output, and extensive pericardial thickening and calcifications ( Figures 1.a and 1.b ). These findings supported the diagnosis of extensive CP. Discussion: CP is often missed and delayed in diagnosis due to its complex hemodynamics and the non-specific symptoms. Typically, the initial imaging modality to be performed is an Echo. Specific findings such as dilated vena cava, preserved tissue velocity with annuls paradoxus, abnormal respiratory septal shift, and respiratory variations in mitral/tricuspid inflow should be first clues for potential diagnosis. Furthermore, evaluation of the hepatic vein with diastolic flow reversal during expiration is a key finding. Lack of respiratory variation in the SVC is also important. Cardiac CT will assess pericardial thickness and calcification, while cardiac MRI is key for the diagnosis by showing the pericardial thickness and fibrosis as well as the septal respiratory shift and venous congestion. An invasive hemodynamic study might be required if imaging is inconclusive. this patient’s presentation, imaging findings, exercise test results and collectively supported considering radical pericardiectomy. Conclusions: This report highlights the diagnostic challenges related to CP and the importance employing a multimodality imaging approach for accurate diagnosis.

AbstractIntroductionPatients with apical myocardial infarction are at higher risk of developing left ventricular (LV) thrombi. Standard transesophageal echocardiography (TEE) is commonly used in assessing cardiac source of embolic cerebrovascular accident (CVA). Contrast‐enhanced transthoracic echocardiography (TTE) improves sensitivity for thrombus detection compared with noncontrast TTE, and however for LV apical thrombi, contrast‐enhanced magnetic resonance imaging (MRI) and/or contrast‐enhanced computed tomography (CT) outperform both TTE and TEE in some studies.CaseA 67‐year‐old man with history of prior myocardial infarction (MI), four‐vessel coronary artery bypass surgery, congestive heart failure with LV ejection fraction of 30%, and diabetes mellitus presented to our facility with acute right occipital‐parietal stroke and recent history of left lower extremity ischemia. Head and neck MRI and MR angiography found multiple posterior circulation infarcts suggestive of cardio‐embolic etiology. TTE image quality was suboptimal even after contrast use to evaluate for LV thrombus, and due to renal insufficiency, MRI or CT was precluded and 3DTEE identified large LV apical thrombus with mobile components.Conclusion3DTEE may increase the detection of LV apical thrombi as well as evaluating its characteristics by live imaging as well as by offline reconstruction. TEE may be a useful diagnostic modality, especially in patients with decreased renal function, where iodinated contrast for cardiac CT or Gadolinium for MRI may be contraindicated. Multimodality imaging studies may further prove the utility of 3D echocardiographic imaging in the detection of LV apical thrombus.