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Marsela E, Hirsch E, Slipczuk L, Travin MI, Moadel RM, Jorde UP, Vukelic S. High-Output Heart Failure in Multiple Myeloma: Novel Application of Tc-99m MAA to Identify Intramedullary Shunting. JACC Case Rep 2024; 29:102387. [PMID: 38912004 PMCID: PMC11193010 DOI: 10.1016/j.jaccas.2024.102387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/25/2024]
Abstract
We introduce the innovative use of technetium-99m-labeled macroaggregated albumin to diagnose high-output heart failure in a patient with multiple myeloma with persistent congestion symptoms. Symptom resolution occurred with lenalidomide and steroids. This marks the first clinical use of technetium-99m-labeled macroaggregated albumin for clarifying high-output heart failure etiology.
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Affiliation(s)
- Enklajd Marsela
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric Hirsch
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Leandro Slipczuk
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mark I. Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Renée M. Moadel
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ulrich P. Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sasa Vukelic
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Etiology of pulmonary hypertension in multiple myeloma: A case series and literature review. Respir Med 2023; 206:107071. [PMID: 36508985 DOI: 10.1016/j.rmed.2022.107071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multiple myeloma is often complicated by pulmonary hypertension through a variety of mechanisms. These mechanisms include pulmonary hypertension (PH) due to concomitant cardiac amyloid, high output heart failure due to anemia or lytic bone lesions, chronic thromboembolic pulmonary hypertension (CTEPH), toxicity from medications to treat multiple myeloma, and congestive heart failure. This case series highlights the various mechanisms through which multiple myeloma patients develop pulmonary hypertension. OBJECTIVES To identify the etiologies of pulmonary hypertension and their management among multiple myeloma patients treated at University of California San Diego. METHODS A retrospective chart review was performed to identify patients with multiple myeloma and pulmonary hypertension who were evaluated at the University of California San Diego between July 2013 and July 2021. Patients also required a right heart catheterization to be included. Demographics, comorbidities, clinical course, and etiology of pulmonary hypertension were obtained from chart review. RESULTS There were 11 patients included. Of the 11 patients described, two had PH due to cardiac amyloid, one had PH due to high output heart failure, one had PH due to CTEPH, two had pulmonary arterial hypertension due to medications (carfilzomib), and five had PH due to congestive heart failure. The right heart catheterization and echocardiogram findings of the various mechanisms of PH in multiple myeloma are described. CONCLUSIONS Pulmonary hypertension in multiple myeloma is a common finding that necessitates further evaluation. The initial evaluation should include an echocardiogram and thorough medication review. Further diagnostic testing should be guided by the patient's history and can include right heart catheterization, cardiac biopsy, ventilation-perfusion scan, and bone scan.
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High Output Heart Failure in Multiple Myeloma: Pathogenetic Considerations. Cancers (Basel) 2022; 14:cancers14030610. [PMID: 35158878 PMCID: PMC8833382 DOI: 10.3390/cancers14030610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Multiple myeloma is a plasma cell disorder that accounts for around 10% of all haematological malignancies. This neoplasia is often associated with a significant prevalence of cardiovascular complications resulting from several factors, unrelated and/or related to the disease. Among cardiovascular complications, the high output heart failure is of great importance as it is related to a worse prognosis for patients. It is important to point out that, despite the availability of more and more numerous and effective drugs, myeloma remains an incurable disease, with frequent relapses and several treatment lines, with the need, therefore, for a careful evaluation of patients, especially from a cardiological point of view. For this reason, we are proposing a comprehensive overview of different pathogenetic mechanisms responsible for high output heart failure in multiple myeloma, including artero-venous shunts, enhanced angiogenesis, glutamminolysis, hyperammonemia and hemorheological alterations, with the belief that a multidisciplinary approach, in clinical evaluation is critical for the optimal management of the patient. Abstract The high output heart failure is a clinical condition in which the systemic congestion is associated to a high output state, and it can be observed in a non-negligible percentage of hematological diseases, particularly in multiple myeloma, a condition in which the risk of adverse cardiovascular events may increase, with a worse prognosis for patients. For this reason, though an accurate literature search, we provided in this review a complete overview of different pathogenetic mechanisms responsible for high output heart failure in multiple myeloma. Indeed, this clinical finding is present in the 8% of multiple myeloma patients, and it may be caused by artero-venous shunts, enhanced angiogenesis, glutamminolysis, hyperammonemia and hemorheological alterations with increase in plasma viscosity. The high output heart failure in multiple myeloma is associated with significant morbidity and mortality, emphasizing the need for a multidisciplinary approach.
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Hemu M, Chiang CJ, Bhatt PK, Ahmed A, Hein KZ, Mourad T, Randall ME, Palomo AP, Kramer JB, Fughhi I, Fogg L, Bonomi P, Okwuosa TM. Associations between sinus tachycardia and adverse cardiovascular outcomes and mortality in cancer patients. J Thorac Dis 2021; 13:4845-4852. [PMID: 34527323 PMCID: PMC8411161 DOI: 10.21037/jtd-21-779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
Background Sinus tachycardia in cancer reflects a significant multi-system organ stressor and disease, with sparse literature describing its clinical significance. We assessed cardiovascular (CV) and mortality prognostic implications of sinus tachycardia in cancer patients. Methods We conducted a case-control study of 622 cancer patients at a U.S. urban medical center from 2008 to 2016. Cases had ECG-confirmed sinus tachycardia [heart rate (HR) ≥100 bpm] in ≥3 different clinic visits within 1 year of cancer diagnosis excluding a history of pulmonary embolism, thyroid dysfunction, left ventricular ejection fraction <50%, atrial fibrillation/flutter, HR >180 bpm. Adverse CV outcomes (ACVO) were heart failure with preserved ejection fraction (HFpEF), HF with reduced EF (HFrEF), hospital admissions for HF exacerbation (AHFE), acute coronary syndrome (ACS). Regression analyses were conducted to examine the effect of sinus tachycardia on overall ACVO and survival. Results There were 51 cases, age and sex-matched with 571 controls (mean age 70±10, 60.5% women, 76.4% Caucasian). In multivariate analysis over a 10-year follow-up period, sinus tachycardia (HR ≥100 vs. <100 bpm) was an independent predictor of overall ACVO (OR 2.8, 95% CI: 1.4–5.5; P=0.006). There was increased incidence of HFrEF (OR 3.3, 95% CI: 1.6–6.5; P=0.004) and AHFE (OR 6.3, 95% CI: 1.6–28; P=0.023), but not HFpEF or ACS (P>0.05) compared with controls. Sinus tachycardia was a significant predictor of overall mortality after adjusting for significant covariates (HR 2.9, 95% CI 1.8–5; P<0.001). Conclusions Independent of typical factors that affect cardiovascular disease, sinus tachycardia around the time of cancer treatment is associated with increased ACVO and mortality in cancer patients at 10 years of follow-up.
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Affiliation(s)
- Mohamad Hemu
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Caleb J Chiang
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Parva K Bhatt
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Aamir Ahmed
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kyaw Zaw Hein
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Talal Mourad
- College of Medicine, University of Illinois, Chicago, IL, USA
| | - Megan E Randall
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Andres P Palomo
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jason B Kramer
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Ibtihaj Fughhi
- Department of Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Louis Fogg
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Philip Bonomi
- Department of Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Tochukwu M Okwuosa
- Director of Cardio-Oncology Services, Department of Cardiology, Rush University Medical Center, Chicago, IL, USA
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Obrezan AG, Shcherbakova NV. [Pathogenetic mechanisms of development of myocardial pathology in patients with malignant tumors: the current state of the problem]. ACTA ACUST UNITED AC 2020; 60:142-154. [PMID: 32345210 DOI: 10.18087/cardio.2020.2.n985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/18/2022]
Abstract
The myocardium, which has a high metabolic activity, responds to metabolic disorders and energy imbalance induced by a growing malignant tumor. In addition, the tumor itself can produce substances that directly affect metabolic processes and the life cycle of cells not involved in the neoplastic process, including cardiomyocytes. This review summarized and systematized current data on individual aspects of detrimental effects of oncogenes and tumor-related factors on the heart muscle and morpho-functional changes in the cardiovascular system of oncology patients. Also, the authors described in detail development of these pathogenetic mechanisms.
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Affiliation(s)
- A G Obrezan
- St. Petersburg State University, SOGAZ International Medical Center, St. Petersburg
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A Case of Multiple Myeloma Presenting with High-Output Heart Failure That Improved with Anti-angiogenesis Therapy. INTERNATIONAL JOURNAL OF HEART FAILURE 2020; 2:204-208. [PMID: 36262362 PMCID: PMC9536680 DOI: 10.36628/ijhf.2020.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022]
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Kistler KD, Kalman J, Sahni G, Murphy B, Werther W, Rajangam K, Chari A. Incidence and Risk of Cardiac Events in Patients With Previously Treated Multiple Myeloma Versus Matched Patients Without Multiple Myeloma: An Observational, Retrospective, Cohort Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:89-96.e3. [PMID: 28025038 DOI: 10.1016/j.clml.2016.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiple myeloma (MM) patients have age-, disease-, and treatment-related risk factors for cardiac events. MATERIALS AND METHODS We analyzed the 2006 to 2011 MarketScan database to determine whether the risk of cardiac events is greater in MM patients than in non-MM patients. Included were 1723 MM patients treated with corticosteroids and ≥ 3 drugs (bortezomib, immunomodulatory derivatives, and alkylating agents or anthracyclines). The index date (ID) was the date on which the 3-drug exposure criterion was met. Also included were 8615 age- and gender-matched non-MM patients (5:1). The distribution of non-MM patients' IDs matched that of the MM patients' IDs. Baseline was 6 months before the ID. The follow-up duration was from the ID to study end (ie, 2011 or end of enrollment or prescription drug coverage). Hazard ratios (HRs) and 95% confidence intervals (CIs) were adjusted for baseline variables when the univariate analyses showed a 10% difference. RESULTS The median duration of observation was 9 months (range, 0-60 months) for MM patients and 19 months (range, 0-66 months) for non-MM patients. The risk of any cardiac event (HR, 2.2; 95% CI, 1.9-2.5), dysrhythmia (HR, 4.1; 95% CI, 3.5-4.8), congestive heart failure (HR, 2.9; 95% CI, 2.2-3.7), cardiomyopathy (HR, 2.6; 95% CI, 1.8-3.8), and conduction disorders (HR, 1.7; 95% CI, 1.2-2.5) was significantly greater for MM than for non-MM patients. The incidence of hypertensive or arterial events and ischemic heart disease was similar between the 2 groups. CONCLUSION The present study provides the first known comparison of cardiac event risk in patients with MM versus age- and gender-matched patients without MM. The cardiac event risk was greater in MM patients with ≥ 3 previous drugs for any cardiac event, dysrhythmias, congestive heart failure, cardiomyopathy, and conduction disorders compared with patients without MM.
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Affiliation(s)
| | - Jill Kalman
- North Shore-Long Island Jewish Health System, Lenox Hill Hospital, New York, NY
| | - Gagan Sahni
- Mount Sinai School of Medicine, New York, NY
| | | | - Winifred Werther
- Onyx Pharmaceuticals, Inc, an Amgen Subsidiary, South San Francisco, CA
| | | | - Ajai Chari
- Mount Sinai School of Medicine, New York, NY
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Krishnan U, Mark TM, Niesvizky R, Sobol I. Pulmonary hypertension complicating multiple myeloma. Pulm Circ 2015; 5:590-7. [PMID: 26401262 PMCID: PMC4556512 DOI: 10.1086/682430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/08/2015] [Indexed: 12/15/2022] Open
Abstract
Pulmonary hypertension (PH) is an infrequently reported complication of multiple myeloma (MM). PH has been more commonly associated with amyloidosis, myeloproliferative diseases, and the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome. PH in MM is typically mild to moderate and may be secondary to a variety of conditions, which include left ventricular dysfunction, high-output cardiac failure, chronic kidney disease, treatment-related toxicities, and precapillary involvement. We describe 3 patients with MM and severe PH. Each patient underwent right heart catheterization. All patients demonstrated elevated pulmonary pressures, transpulmonary gradients, and pulmonary vascular resistance. Each patient was ultimately treated with pulmonary vasodilator therapy with improvement in cardiopulmonary symptoms. Additional studies are needed to define the prevalence, prognosis, and pathogenesis of PH in this complex population and to help clarify who may benefit from targeted PH therapy.
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Affiliation(s)
- Udhay Krishnan
- Division of Cardiology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Tomer M. Mark
- Division of Hematology and Medical Oncology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Ruben Niesvizky
- Division of Hematology and Medical Oncology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Irina Sobol
- Division of Cardiology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
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Remote Stab Wound Resulting in AV Fistula and High-Output Heart Failure. Case Rep Cardiol 2013; 2013:902719. [PMID: 24826298 PMCID: PMC4008354 DOI: 10.1155/2013/902719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/16/2013] [Indexed: 11/20/2022] Open
Abstract
A 54-year-old African American male with no medical history presented to an urgent care clinic with signs and symptoms of new-onset congestive heart failure. There was an initial concern for congestive heart failure secondary to an ischemic etiology as an echocardiogram revealed a depressed ejection fraction. However, a left heart cardiac catheterization did not demonstrate any significant coronary disease. As a loud bruit was auscultated over the right base of the patient's neck, he underwent a carotid duplex ultrasound revealing a fistula between the right common carotid artery (CCA) and the right internal jugular vein (IJV). A diagnosis of high-output heart failure secondary to a large arteriovenous (AV) fistula was made, and the patient underwent ligation and repair of the fistula with resolution of symptoms of congestive heart failure.
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High-output cardiac failure revealing primary plasma cell leukemia. Case Rep Hematol 2013; 2013:504612. [PMID: 23533848 PMCID: PMC3603641 DOI: 10.1155/2013/504612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 02/11/2013] [Indexed: 11/24/2022] Open
Abstract
High-output cardiac failure in multiple myeloma (MM) is related to arteriovenous shunting in bone infiltrate disease. We describe such a complication in a patient with primary plasma cell leukemia (pPCL) without bone disease. We review the mechanisms that could be involved. As previously described, traditional cardiac failure therapy is not effective. pPCL therapy should not be delayed.
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Theophylline is able to partially revert cachexia in tumour-bearing rats. Nutr Metab (Lond) 2012; 9:76. [PMID: 22909172 PMCID: PMC3495887 DOI: 10.1186/1743-7075-9-76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 04/30/2012] [Indexed: 01/03/2023] Open
Abstract
Background and aims The aim of the present investigation was to examine the anti-wasting effects of theophylline (a methylxantine present in tea leaves) on a rat model of cancer cachexia. Methods The in vitro effects of the nutraceuticals on proteolysis were examined on muscle cell cultures submitted to hyperthermia. Individual muscle weights, muscle gene expression, body composition and cardiac function were measured in rats bearing the Yoshida AH-130 ascites hepatoma, following theophylline treatment. Results Theophylline treatment inhibited proteolysis in C2C12 cell line and resulted in an anti-proteolytic effect on muscle tissue (soleus and heart), which was associated with a decrease in circulating TNF-alpha levels and with a decreased proteolytic systems gene expression. Treatment with the nutraceutical also resulted in an improvement in body composition and cardiac function. Conclusion Theophylline - alone or in combination with drugs - may be a candidate molecule for the treatment of cancer cachexia.
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Robin J, Fintel B, Pikovskaya O, Davidson C, Cilley J, Flaherty J. Multiple myeloma presenting with high-output heart failure and improving with anti-angiogenesis therapy: two case reports and a review of the literature. J Med Case Rep 2008; 2:229. [PMID: 18627621 PMCID: PMC2500028 DOI: 10.1186/1752-1947-2-229] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 07/15/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Common manifestations of multiple myeloma include osteolytic lesions, cytopenias, hypercalcemia, and renal insufficiency. Patients may also exhibit heart failure which is often associated with either past therapy or cardiac amyloidosis. A less recognized mechanism is high-output heart failure. Diuretic therapy in this setting has little efficacy in treating the congested state. Furthermore, effective pharmacotherapy has not been established. We report two patients with multiple myeloma and high-output heart failure who failed diuretic therapy. The patients were given dexamethasone in conjunction with lenalidomide and thalidomide, respectively. Shortly thereafter, each patient demonstrated a significant improvement in symptoms. This is the first report of successful treatment of multiple myeloma-induced high-output failure via the utilization of these agents. CASE PRESENTATION Two patients with multiple myeloma were evaluated for volume overload. The first was a 50-year-old man with refractory disease. Magnetic resonance imaging demonstrated diffuse marrow replacement throughout the pelvis. Cardiac catheterization conveyed elevated filling pressures and a cardiac output of 15 liters/minute. He quickly decompensated and required mechanical ventilation. The second patient was a 61-year-old man recently diagnosed with multiple myeloma and volume overload. Skeletal survey demonstrated numerous lytic lesions throughout the pelvis. His cardiac catheterization also conveyed elevated filling pressures and a cardiac output of 10 liters/minute. Neither patient responded to diuretic therapy and they were subsequently started on dexamethasone plus lenalidomide and thalidomide, respectively. The first patient's brisk diuresis allowed for extubation within 48 hours after the first dose. He had a net negative fluid balance of 15 liters over 10 days. The second patient also quickly diuresed and on repeat cardiac catheterization, his cardiac output had normalized to 4.7 liters/minute. CONCLUSION Multiple myeloma can cause high-output failure. The mechanism is likely extensive bony involvement causing innumerable intramedullary arteriovenous fistulas. Diuretic therapy is not effective in treating this condition. Lenalidomide and thalidomide, both of which inhibit angiogenesis, seem to be viable treatment options. Based on the rapid and effective results seen in these two patients, a potential novel mechanism of 'pharmacologic fistula ligation' with these agents may be the most effective way to treat this presentation.
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Affiliation(s)
- Jason Robin
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Kohrt H, Logan A, Temmins C, Witteles R, Liedtke M, Medeiros B. Reversible high-output cardiac failure, an unusual marker of disease status in multiple myeloma. Leuk Lymphoma 2008; 49:581-5. [DOI: 10.1080/10428190701861702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sasaki K, Yamashita K, Miyoshi T, Furukawa Y, Kimura T, Kita T, Ichinohe T, Ishikawa T, Sasada M, Uchiyama T. Analysis of serum angiogenic factors in a young multiple myeloma patient with high-output cardiac failure. Int J Hematol 2007; 86:72-6. [PMID: 17675271 DOI: 10.1532/ijh97.06226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Angiogenesis is believed to be involved in the pathogenesis and progression of multiple myeloma (MM). In some young patients, the MM has been reported to be complicated with high-output cardiac failure (HOCF), in which an increase in the vascular bed may be involved in the pathogenesis; however, no throughput studies have been conducted to determine what angiogenic factors are associated with HOCF in MM patients. We experienced a 34-year-old MM patient with HOCF and used the cytokine array system to investigate the expression of angiogenic cytokines and related factors in his serum before and after treatment and to compare the results with those of a healthy volunteer. We treated the patient with chemotherapy in combination with autologous peripheral blood stem cell transplantation. Following the treatment, he showed a good partial response without any signs of cardiac failure. The patient had experienced dramatic increases in the expression levels of angiopoietin 2, insulin-like growth factor-binding protein 6, and glial cell line-derived neurotrophic factor. After treatment, the levels of these factors decreased remarkably in association with an improvement in the patient's clinical condition. We review previous case reports in our discussion of the significance of these findings in the pathogenesis of MM with HOCF.
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Affiliation(s)
- Kazunari Sasaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
BACKGROUND There is limited published information regarding feline multiple myeloma. Diagnostic criteria are derived from canine studies and to our knowledge, have not been critically reviewed for cats. OBJECTIVE To evaluate the clinical and laboratory findings in cats with multiple myeloma and appraise diagnostic criteria. METHODS Retrospective evaluation of medical records was performed. Inclusion required an antemortem diagnosis of multiple myeloma using 2 of 4 criteria: 1) >or=20% plasma cells in the bone marrow, or >or=10% if atypical plasma cells; 2) paraproteinemia; 3) radiographically-evident osteolysis; 4) light chain proteinuria. Alternatively, a postmortem diagnosis was based on the findings of multiple plasma cell neoplasms, with marrow involvement. RESULTS Sixteen cats were diagnosed with multiple myeloma between 1996 and 2004, with a median age of 14.0 years; 9 of 16 (56%) were castrated males, and 7 of 16 (44%) were spayed females. Laboratory abnormalities included hyperglobulinemia (14/16, 87.5%), with 11/14 (78.5%) monoclonal and 3/14 (21.4%) biclonal gammopathies; hypoalbuminemia (4/16, 25%); light chain proteinuria, (4/9, 44.4%); hypocholesterolemia (11/16, 68.7%); hypercalcemia, (3/15, 20%); nonregenerative anemia, (11/16, 68.7%); regenerative anemia, (1/16, 6.2%); neutropenia (5/15, 33.3%); thrombocytopenia (8/16, 50%); and marrow plasmacytosis (14/15, 93.3%). Plasma cells were markedly immature, atypical, or both in 10 of 12 (83.3%) cats. Focal or multifocal osteolysis was noted in 6 of 12 (50%) cats for which radiographs were available for review; generalized osteopenia was found in 1 (8.3%) cat. Noncutaneous, extramedullary tumors were found in all cats assessed, 7/7 (100%), including spleen (6), liver (3), and lymph nodes (4). The disease in 1 of 2 cats with cutaneous tumors progressed to plasmacytic leukemia. CONCLUSIONS Common findings in feline multiple myeloma include atypical plasma cell morphology, hypocholesterolemia, anemia, bone lesions, and multi-organ involvement. Based on the results of this study, we advocate modifying diagnostic criteria in cats to include consideration of plasma cell morphology and visceral organ infiltration.
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Affiliation(s)
- Reema T. Patel
- From the Departments of Pathobiology (Patel, French, McManus) and Clinical Studies (Caceres), School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA. Dr. McManus now is with Veterinary Diagnostic Imaging and Cytopathology, 16900 SE 82nd Drive, Clackamas, OR. This study was presented, in part, at the 38th Annual Meeting of the American Society for Veterinary Clinical Pathology, Banff Springs, Alberta, Canada, November 15–19, 2003. Corresponding author: Patricia M. McManus ()
| | - Ana Caceres
- From the Departments of Pathobiology (Patel, French, McManus) and Clinical Studies (Caceres), School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA. Dr. McManus now is with Veterinary Diagnostic Imaging and Cytopathology, 16900 SE 82nd Drive, Clackamas, OR. This study was presented, in part, at the 38th Annual Meeting of the American Society for Veterinary Clinical Pathology, Banff Springs, Alberta, Canada, November 15–19, 2003. Corresponding author: Patricia M. McManus ()
| | - Adrienne F. French
- From the Departments of Pathobiology (Patel, French, McManus) and Clinical Studies (Caceres), School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA. Dr. McManus now is with Veterinary Diagnostic Imaging and Cytopathology, 16900 SE 82nd Drive, Clackamas, OR. This study was presented, in part, at the 38th Annual Meeting of the American Society for Veterinary Clinical Pathology, Banff Springs, Alberta, Canada, November 15–19, 2003. Corresponding author: Patricia M. McManus ()
| | - Patricia M. McManus
- From the Departments of Pathobiology (Patel, French, McManus) and Clinical Studies (Caceres), School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA. Dr. McManus now is with Veterinary Diagnostic Imaging and Cytopathology, 16900 SE 82nd Drive, Clackamas, OR. This study was presented, in part, at the 38th Annual Meeting of the American Society for Veterinary Clinical Pathology, Banff Springs, Alberta, Canada, November 15–19, 2003. Corresponding author: Patricia M. McManus ()
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Nakamura M, Satoh M, Kowada S, Satoh H, Tashiro A, Sato F, Masuda T, Hiramori K. Reversible restrictive cardiomyopathy due to light-chain deposition disease. Mayo Clin Proc 2002; 77:193-6. [PMID: 11838655 DOI: 10.4065/77.2.193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic light-chain deposition due to plasma cell dyscrasias manifests as a form of restrictive cardiomyopathy with diastolic ventricular dysfunction. Although these manifestations are likely to be cardiac amyloidosis, whether these pathological conditions are reversible after treatment of the underlying plasma cell disorders is unknown. To our knowledge, we describe the first patient with cardiac light-chain deposition due to multiple myeloma in whom echocardiographic and biochemical factors of cardiac function were ameliorated dramatically after remission of this disorder. We emphasize that restrictive cardiomyopathy due to light-chain deposition may be reversible and have a relatively better prognosis after remission of plasma cell dyscrasias.
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Affiliation(s)
- Motoyuki Nakamura
- Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
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Greci LS, Rashkow A. High-output cardiac failure in a patient with prostate cancer. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2001; 7:220-222. [PMID: 11828171 DOI: 10.1111/j.1527-5299.2001.01010.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The authors describe a case of high-output cardiac failure in a patient with rapidly progressing prostate cancer for which no previously described cause could be found. His new onset and increasingly worsening heart failure corresponded to the rapid spread of his prostate cancer. The authors hypothesize that a cytokine released from the neoplastic cells or the bone was responsible for the high-output cardiac failure observed in this patient. (c)2001 CHF, Inc.
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Affiliation(s)
- L S Greci
- The Departments of Internal and Preventive Medicine, Griffin Hospital, Yale University School of Medicine, Derby, CT 06418
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Abstract
A large number of observations point towards cytokines, polypeptides released mainly by immune cells, as the molecules responsible for the metabolic derangements associated with cancer-bearing states. Indeed, these alterations lead to a pathological state known as cancer cachexia which is, unfortunately, one of the worst effects of malignancy, accounting for nearly a third of cancer deaths. It is characterized by weight loss together with anorexia, weakness, anemia, and asthenia. The complications associated with the appearance of the cachectic syndrome affect both the physiological and biochemical balance of the patient and have effects on the efficiency of the anticancer treatment, resulting in a considerably decreased survival time. At the metabolic level, cachexia is associated with loss of skeletal muscle protein together with a depletion of body lipid stores. The cachectic patient, in addition to having practically no adipose tissue, is basically subject to an important muscle wastage manifested as an excessive nitrogen loss. The metabolic changes are partially mediated by alterations in circulating hormone concentrations (insulin, glucagon, and glucocorticoids in particular) or in their effectiveness. The present study reviews the involvement of different cytokines in the metabolic and physiological alterations associated with tumor burden and cachexia. Among these cytokines, some can be considered as procachectic (such as tumor necrosis factor-alpha), while others having opposite effects can be named as anticachectic cytokines. It is the balance between these two cytokine types that finally seems to have a key role in cancer cachexia.
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Affiliation(s)
- J M Argilés
- Department de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Spain.
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Kuribayashi N, Matsuzaki H, Hata H, Yoshida M, Sonoki T, Nagasaki A, Kimura T, Okamoto K, Kurose M, Tsuda H, Takatsuki K. Multiple myeloma associated with serum amino acid disturbance and high output cardiac failure. Am J Hematol 1998; 57:77-81. [PMID: 9423822 DOI: 10.1002/(sici)1096-8652(199801)57:1<77::aid-ajh14>3.0.co;2-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We experienced a plasma cell leukemia (PCL) patient complicated with high output cardiac failure (HOCF), proved as his elevated cardiac index and pulmonary artery wedge pressure and decreased systemic vascular resistance index in a hemodynamic study. We found no possible causes of HOCF. Interestingly, HOCF was improved as PCL responded to intensive chemotherapy. On the other hand, he showed consciousness disturbance, and had frequent attacks of generalized seizure. His electroencephalogram showed slow waves, and a spike and wave complex. Hyperammonemia and abnormal amino acid distribution were also found. This abnormal serum amino acid distribution, especially elevated glycine level, was different from that seen in chronic liver failure, and he had no hepatic disease. After intensive chemotherapy, the serum ammonia level and glycine level decreased. In this patient, PCL seemed to be responsible for HOCF, hyperammonemia, and abnormal amino acid distribution. We experienced two more cases of multiple myeloma (MM) with HOCF, hyperammonemia, abnormal serum amino acid distribution, and consciousness disturbance of unknown origin. Those two cases showed slow waves in the electroencephalogram. Improvement was seen in their HOCF, hyperammonemia, and abnormal amino acid levels after chemotherapy. The possibility of MM as a cause of HOCF is discussed.
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Affiliation(s)
- N Kuribayashi
- The Second Department of Internal Medicine, Kumamoto University School of Medicine, Japan
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Affiliation(s)
- J M Argilés
- Department de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Spain.
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Kosinski DJ, Roush K, Fraker TD, Grubb BP. High cardiac output state in patients with multiple myeloma: case report and review of the literature. Clin Cardiol 1994; 17:678-80. [PMID: 7867242 DOI: 10.1002/clc.4960171211] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A high cardiac output state, with or without congestive heart failure, has recently been recognized in patients with multiple myeloma. This case report deals with a 62-year-old man with multiple myeloma refractory to treatment, a high cardiac output state, and life-threatening pulmonary edema. In addition, a brief review of the literature is presented.
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Affiliation(s)
- D J Kosinski
- Department of Medicine, Medical College of Ohio, Toledo 43699
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22
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Broussard HJ, Lang C, Burns AH. Myocardial effects of experimental neoplastic disease. Life Sci 1994; 54:287-93. [PMID: 8289590 DOI: 10.1016/0024-3205(94)00819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to determine the effects of the 7288ctc Morris hepatoma on heart size and performance. Hearts from tumor bearing and control animals were perfused in the working configuration one to three weeks post implantation. As tumor growth progressed there was an inverse linear relationship between tumor size and heart weight. When intrinsic heart work (defined as the product of the cardiac output and peak systolic pressure) was assessed in vitro over a range of physiologic preloads, significant differences were found between tumor-bearing and non-tumor-bearing animals. The hearts from the tumor-bearing animals (tumor weight 10-20 grams) developed only 76% of the heart work of control animals at maximal left atrial filling pressure (25 cm H2O). Hearts excised from rats with tumor masses from 30-65 grams developed 43% of the myocardial work as controls at the same (25 cm) preload. At the time of sacrifice resting blood pressures, blood glucose, insulin, and tumor necrosis factor (TNF) levels were similar in both groups. Blood from tumor bearing animals were negative for both aerobic and anaerobic bacteria. The data suggests that the decrements in cardiac size and performance are independent of several vectors known to influence heart size and performance and occur in the absence of detectable bacteremia.
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Affiliation(s)
- H J Broussard
- Dept. of Physiology, LSU Medical Center, New Orleans 70112
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