1
|
Murad H, Leal JCF, de Almeida RMDSSA, Nina VJDS. Pericardial involvement in neoplastic diseases. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S105. [PMID: 38865525 PMCID: PMC11164287 DOI: 10.1590/1806-9282.2024s105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Henrique Murad
- Universidade Federal do Rio de Janeiro, Brazilian Society of Cardiovascular Surgery – Rio de Janeiro (RJ), Brazil
| | - João Carlos Ferreira Leal
- Universidade Estadual de São Paulo, São José do Rio Preto Medical School, Brazilian Society of Cardiovascular Surgery – São José do Rio Preto (SP), Brazil
| | | | | |
Collapse
|
2
|
Gan T, Chen J, Wang H, Shang C, Xi S, Fan Z, He B, Zhang M, Zhao L. Impact of sequential (first- to third-generation) EGFR-TKI treatment on corrected QT interval in NSCLC patients. Front Oncol 2024; 14:1330165. [PMID: 38774407 PMCID: PMC11106428 DOI: 10.3389/fonc.2024.1330165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/18/2024] [Indexed: 05/24/2024] Open
Abstract
Objective To evaluate the impact of sequential (first- to third-generation) epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment on top-corrected QT interval (top-QTc) in non-small cell lung cancer (NSCLC) patients. Methods We retrospectively reviewed the medical records of NSCLC patients undergoing sequential EGFR-TKI treatment at Shanghai Chest Hospital between October 2016 and August 2021. The heart rate (HR), top-QT interval, and top-QTc of their ECGs were extracted from the institutional database and analyzed. Logistic regression was performed to identify predictors for top-QTc prolongation. Results Overall, 228 patients were enrolled. Compared with baseline (median, 368 ms, same below), both first-generation (376 ms vs. 368 ms, p < 0.001) and sequential third-generation EGFR-TKIs (376 ms vs. 368 ms, p = 0.002) prolonged top-QT interval to a similar extent (p = 0.635). Top-QTc (438 ms vs. 423 ms, p < 0.001) and HR (81 bpm vs.79 bpm, p = 0.008) increased after first-generation EGFR-TKI treatment. Further top-QTc prolongation (453 ms vs. 438 ms, p < 0.001) and HR increase (88 bpm vs. 81 bpm, p < 0.001) occurred after treatment advanced. Notably, as HR elevated during treatment, top-QT interval paradoxically increased rather than decreased, and the top-QTc increased rather than slightly fluctuated. Moreover, such phenomena were more significant after treatment advanced. After adjusting for confounding factors, pericardial effusion and lower serum potassium levels were independent predictors of additional QTc prolongation during sequential third-generation EGFR-TKI treatment. Conclusion First-generation EGFR-TKI could prolong top-QTc, and sequential third-generation EGFR-TKI induced further prolongation. Top-QT interval paradoxically increased and top-QTc significantly increased as HR elevated, which was more significant after sequential EGFR-TKI treatment. Pericardial effusion and lower serum potassium levels were independent predictors of additional QTc prolongation after sequential EGFR-TKI treatment.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Zhao
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
3
|
von Kemp BA, Cosyns B. Radiation-Induced Pericardial Disease: Mechanisms, Diagnosis, and Treatment. Curr Cardiol Rep 2023; 25:1113-1121. [PMID: 37584875 DOI: 10.1007/s11886-023-01933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW We aim to give a concise overview of the different clinical manifestations of both acute and long-term radiotherapy-related pericardial diseases, the underlying pathophysiology as well as the diagnosis and treatment options. RECENT FINDINGS Radiotherapy-related pericardial disease is common, but despite radiotherapy being a cornerstone of many cancer treatments, this disease entity is relatively underrepresented in clinical trials, resulting in a paucity of research data on pathophysiology and management. Since the development of innovative cancer treatments, survival has significantly improved. Therefore, the importance of long-term treatment-related side effects increases, most notably cancer treatment-related cardiovascular toxicity. In patients undergoing radiotherapy as a part of their cancer treatment, radiotherapy-related pericardial disease can manifest early (during or shortly after radiotherapy administration) or very late (several years to decades after treatment). This exceptionally long latency period confronts physicians with treatment-related side effects of radiotherapy regimens that may have been abandoned already.
Collapse
Affiliation(s)
- Berlinde A von Kemp
- Dienst Cardiologie, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Bernard Cosyns
- Dienst Cardiologie, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| |
Collapse
|
4
|
Abusuliman M, Mohamed AM, Mahmoud A, Beliani T, Ismail-Sayed IM. Peritoneal Carcinoma Unveiling a Hidden Threat: A Case of Malignant Pericardial Effusion. Cureus 2023; 15:e46059. [PMID: 37900376 PMCID: PMC10605546 DOI: 10.7759/cureus.46059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Malignant pericardial effusion (MPE) is a slowly progressive and potentially clinically silent condition. Pericardial effusion can arise in oncology patients due to several factors, including disease spreading directly or metastatically, anticancer therapy side effects, or both. Solid and hematological malignancy metastasis more frequently involves the pericardium than primary tumors, with lung cancer being the most common metastatic tumor to involve the pericardium. While 5%-20% of all patients with metastatic neoplasms have pericardial involvement, MPE rarely appears with hemodynamic instability. Occasionally, MPE constitutes the initial manifestation of an underlying malignancy. Diagnosis and treatment require a multidisciplinary approach and a high degree of clinical suspicion. We present a case of a 59-year-old female with a history of peritoneal carcinoma who presented with persistent dyspnea on exertion following an episode of pneumonia that was treated with antibiotics. Physical examination and bedside point-of-care ultrasound (POCUS) revealed fluid in the pericardial sac. The cytological examination of the fluid revealed it to be of malignant origin, resulting from metastasis from gynecologic adenocarcinoma. Pericardiocentesis was done, and symptoms improved after fluid drainage.
Collapse
Affiliation(s)
| | - Amr M Mohamed
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Tala Beliani
- Medicine, Kansas City University, Kansas City, USA
| | | |
Collapse
|
5
|
Camilli M, Viscovo M, Hohaus S, Lamendola P, Verrecchia E, Gerardino L, Crea F, Lombardo A, Manna R. Incessant Pericarditis Successfully Treated With Anakinra in a Patient on Active Treatment for Mediastinal Lymphoma. Can J Cardiol 2023; 39:1154-1157. [PMID: 36334641 DOI: 10.1016/j.cjca.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Massimiliano Camilli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marcello Viscovo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Stefan Hohaus
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Priscilla Lamendola
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Verrecchia
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Periodic Fevers Research Center, Catholic University of the Sacred Heart, Rome, Italy
| | - Laura Gerardino
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Periodic Fevers Research Center, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Raffaele Manna
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Periodic Fevers Research Center, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
6
|
Chen J, Cao S, Jin Y, Rong W, Wang H, Xi S, Gan T, He B, Zhong H, Zhao L. Construction and validation of a nomogram of risk factors for new-onset atrial fibrillation in advanced lung cancer patients after non-surgical therapy. Front Oncol 2023; 13:1125592. [PMID: 37519821 PMCID: PMC10374250 DOI: 10.3389/fonc.2023.1125592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Risk factors of new-onset atrial fibrillation (NOAF) in advanced lung cancer patients are not well defined. We aim to construct and validate a nomogram model between NOAF and advanced lung cancer. Methods We retrospectively enrolled 19484 patients with Stage III-IV lung cancer undergoing first-line antitumor therapy in Shanghai Chest Hospital between January 2016 and December 2020 (15837 in training set, and 3647 in testing set). Patients with pre-existing AF, valvular heart disease, cardiomyopathy were excluded. Logistic regression analysis and propensity score matching (PSM) were performed to identify predictors of NOAF, and nomogram model was constructed and validated. Results A total of 1089 patients were included in this study (807 in the training set, and 282 in the testing set). Multivariate logistic regression analysis showed that age, c-reactive protein, centric pulmonary carcinoma, and pericardial effusion were independent risk factors, the last two of which were important independent risk factors as confirmed by PSM analysis. Nomogram included independent risk factors of age, c-reactive protein, centric pulmonary carcinoma, and pericardial effusion. The AUC was 0.716 (95% CI 0.661-0.770) and further evaluation of this model showed that the C-index was 0.716, while the bias-corrected C-index after internal validation was 0.748 in the training set. The calibration curves presented good concordance between the predicted and actual outcomes. Conclusion Centric pulmonary carcinoma and pericardial effusion were important independent risk factors for NOAF besides common ones in advanced lung cancer patients. Furthermore, the new nomogram model contributed to the prediction of NOAF.
Collapse
Affiliation(s)
- Jindong Chen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuhui Cao
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Jin
- Department of Respiratory Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wenwen Rong
- Department of Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siqi Xi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Gan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Zhong
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Zhao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
7
|
Bhasin-Chhabra B, Koratala A. Point of care ultrasonography in onco-nephrology: A stride toward better physical examination. World J Nephrol 2023; 12:29-39. [PMID: 37035508 PMCID: PMC10075017 DOI: 10.5527/wjn.v12.i2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023] Open
Abstract
Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.
Collapse
Affiliation(s)
- Bhavna Bhasin-Chhabra
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| |
Collapse
|
8
|
Naicker K, Dalvie S, Said-Hartley Q, Ntsekhe M. Concurrent tuberculous pericarditis and lung adenocarcinoma presenting with cardiac tamponade. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2023. [DOI: 10.4102/sajo.v7i0.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
9
|
Uchida T, Matsubara H, Muto M, Sasanuma H, Sugimura S, Onuki Y, Nakajima H. Long-term survival of a patient with lung cancer treated with pembrolizumab after recurrent cardiac tamponade. Clin Case Rep 2022; 10:e6795. [PMID: 36590662 PMCID: PMC9795085 DOI: 10.1002/ccr3.6795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/17/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
A 69-year-old man with non-small cell lung cancer presenting with pericardial effusion and rapid progression of dyspnea achieved long-term disease stabilization after radiation therapy and immunotherapy. This case shows that pembrolizumab may improve prognosis in advanced lung cancer, even when complicated by cardiac tamponade.
Collapse
Affiliation(s)
- Tsuyoshi Uchida
- Department of Thoracic SurgeryUniversity of YamanashiChuoJapan
| | | | - Mamoru Muto
- Department of Thoracic SurgeryUniversity of YamanashiChuoJapan
| | | | - Saya Sugimura
- Department of Thoracic SurgeryUniversity of YamanashiChuoJapan
| | - Yuichiro Onuki
- Department of Thoracic SurgeryUniversity of YamanashiChuoJapan
| | | |
Collapse
|
10
|
Jin X, Hu L, Fang M, Zheng Q, Yuan Y, Lu G, Li T. Development and validation a simple scoring system to identify malignant pericardial effusion. Front Oncol 2022; 12:1012664. [DOI: 10.3389/fonc.2022.1012664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BackgroundMalignant pericardial effusion (MPE) is a serious complication in patients with advanced malignant tumors, which indicates a poor prognosis. However, its clinical manifestations lack specificity, making it challenging to distinguish MPE from benign pericardial effusion (BPE). The aim of this study was to develop and validate a scoring system based on a nomogram to discriminate MPE from BPE through easy-to-obtain clinical parameters.MethodsIn this study, the patients with pericardial effusion who underwent diagnostic pericardiocentesis in Taizhou Hospital of Zhejiang Province from February 2013 to December 2021 were retrospectively analyzed. The eligible patients were divided into a training group (n = 161) and a validation group (n = 66) according to the admission time. The nomogram model was established using the meaningful indicators screened by the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression. Then, a new scoring system was constructed based on this nomogram model.ResultsThe new scoring system included loss of weight (3 points), no fever (4 points), mediastinal lymph node enlargement (2 points), pleural effusion (6 points), effusion adenosine deaminase (ADA≦18U/L) (5 points), effusion lactate dehydrogenase (LDH>1033U/L) (7 points), and effusion carcinoembryonic antigen (CEA>4.9g/mL) (10 points). With the optimal cut-off value was 16 points, the area under the curve (AUC), specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) for identifying MPE were 0.974, 95.1%, 91.0%, 85.6%, 96.8%, 10.56 and 0.05, respectively, in the training set and 0.950, 83.3%, 95.2%, 90.9%, 90.9%, 17.50, and 0.18, respectively, in the validation set. The scoring system also showed good diagnostic accuracy in differentiating MPE caused by lung cancer from tuberculous pericardial effusion (TPE) and MPE including atypical cell from BPE.ConclusionThe new scoring system based on seven easily available variables has good diagnostic value in distinguishing MPE from BPE.
Collapse
|
11
|
Nakata A, Takamatsu H, Eguchi Y, Izumida T, Aburadani I, Hirota S, Takagawa K. Primary Cardiac Lymphoma Arising from Both Sides of the Heart. Intern Med 2022; 61:3377-3381. [PMID: 35491130 PMCID: PMC9751723 DOI: 10.2169/internalmedicine.8936-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Primary cardiac lymphomas (PCLs) are extremely rare tumors with a poor prognosis. They usually involve the pericardium and the right side of the heart. PCLs arising from the left side of the heart are relatively rare, with bilateral cases being even rarer. We herein report a case of PCL arising from both the right and left sides of the heart in a 65-year-old man. Multiple imaging modalities clearly demonstrated the tumors at the initial evaluation. The pathological diagnosis was diffuse large B-cell lymphoma.
Collapse
Affiliation(s)
- Akio Nakata
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | | | - Yuya Eguchi
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | | | - Isao Aburadani
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | - Satoshi Hirota
- Department of Internal Medicine, Kurobe City Hospital, Japan
| | | |
Collapse
|
12
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 734] [Impact Index Per Article: 367.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
13
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
14
|
Patil NS, Larocque N, van der Pol CB, Torres C, Raptis DA, Patlas MN. Chemotherapy-Induced Toxicities: An Imaging Primer. Can Assoc Radiol J 2022; 74:432-445. [PMID: 35968850 DOI: 10.1177/08465371221120263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.
Collapse
Affiliation(s)
- Nikhil S. Patil
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Natasha Larocque
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Christian B. van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Canada
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Demetrios A. Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, USA
| | | |
Collapse
|
15
|
Almajed MR, Obri MS, Kamran W, Entz A. Malignant Cardiac Tamponade: A Complication of Untreated Breast Cancer. Cureus 2022; 14:e26787. [PMID: 35967180 PMCID: PMC9366026 DOI: 10.7759/cureus.26787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
Carcinomatous pericarditis is a rare complication of locally aggressive breast cancer in which malignant cells directly extend into the pericardium causing inflammation and creating a pericardial effusion. A 40-year-old woman with untreated metastatic breast cancer presented to an outpatient clinic in significant distress with symptoms of progressive shortness of breath and bilateral leg swelling. An urgent echocardiogram demonstrated a large pericardial effusion with echocardiographic evidence of cardiac tamponade. She underwent emergent pericardiocentesis of the effusion that was deemed to be malignant after cytologic evaluation. Subsequently, she opted for palliative treatment involving the surgical creation of a right pericardial window and placement of an indwelling pleural catheter. Internists should maintain a high index of suspicion for malignant cardiac tamponade in at-risk patients, especially those with locally aggressive and advanced malignancies.
Collapse
|
16
|
Tyebally S, Ghose A, Chen DH, Abiodun AT, Ghosh AK. Chest Pain in the Cancer Patient. Eur Cardiol 2022; 17:e15. [PMID: 35702571 PMCID: PMC9185574 DOI: 10.15420/ecr.2021.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Chest pain is one of the most common presenting symptoms in patients seeking care from a physician. Risk assessment tools and scores have facilitated prompt diagnosis and optimal management in these patients; however, it is unclear as to whether a standardised approach can adequately triage chest pain in cancer patients and survivors. This is of concern because cancer patients are often at an increased risk of cardiovascular mortality and morbidity given the shared risk factors between cancer and cardiovascular disease, compounded by the fact that certain anti-cancer therapies are associated with an increased risk of cardiovascular events that can persist for weeks and even years after treatment. This article describes the underlying mechanisms of the most common causes of chest pain in cancer patients with an emphasis on how their management may differ to that of non-cancer patients with chest pain. It will also highlight the role of the cardio-oncology team, who can aid in identifying cancer therapy-related cardiovascular side-effects and provide optimal multidisciplinary care for these patients.
Collapse
Affiliation(s)
- Sara Tyebally
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Aruni Ghose
- Oncology Department, St Bartholomew’s Hospital, London, UK
| | - Daniel H Chen
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK; Hatter Cardiovascular Institute, UCL Institute of Cardiovascular Science, University College London Hospital, London, UK
| | - Aderonke T Abiodun
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK; Hatter Cardiovascular Institute, UCL Institute of Cardiovascular Science, University College London Hospital, London, UK
| |
Collapse
|
17
|
Ahmed T, Mouhayar E, Song J, Koutroumpakis E, Palaskas NL, Yusuf SW, Lopez-Mattei J, Hassan SA, Kim P, Cilingiroglu M, Marmagkiolis K, Vaporciyan AA, Swisher S, Deswal A, Iliescu C. Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis. Front Cardiovasc Med 2022; 9:916325. [PMID: 35711368 PMCID: PMC9192944 DOI: 10.3389/fcvm.2022.916325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
Aim This study investigated the factors predicting survival and the recurrence of pericardial effusion (PE) requiring pericardiocentesis (PCC) in patients with cancer. Materials and Methods We analyzed the data of patients who underwent PCC for large PEs from 2010 to 2020 at The University of Texas MD Anderson Cancer Center. The time to the first recurrent PE requiring PCC was the interval from the index PCC with pericardial drain placement to first recurrent PE requiring drainage (either repeated PCC or a pericardial window). Univariate and multivariate Fine-Gray models accounting for the competing risk of death were used to identify predictors of recurrent PE requiring drainage. Cox regression models were used to identify predictors of death. Results The study cohort included 418 patients with index PCC and pericardial drain placement, of whom 65 (16%) had recurrent PEs requiring drainage. The cumulative incidences of recurrent PE requiring drainage at 12 and 60 months were 15.0% and 15.6%, respectively. Younger age, anti-inflammatory medication use, and solid tumors were associated with an increased risk of recurrence of PE requiring drainage, and that echocardiographic evidence of tamponade at presentation and receipt of immunotherapy were associated with a decreased risk of recurrence. Factors predicting poor survival included older age, malignant effusion on cytology, non-use of anti-inflammatory agents, non-lymphoma cancers and primary lung cancer. Conclusion Among cancer patients with large PEs requiring drainage, young patients with solid tumors were more likely to experience recurrence, while elderly patients and those with lung cancer, malignant PE cytology, and non-use of anti-inflammatory agents showed worse survival.
Collapse
Affiliation(s)
- Talha Ahmed
- Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elie Mouhayar
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juhee Song
- Department of Biostatistics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas L. Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir A. Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ara A. Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephen Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Cezar Iliescu,
| |
Collapse
|
18
|
He J, Hu X, Chen L, Liu Q, Jiang Y. Characteristics of Genomic Alterations in Pericardial Effusion of Advanced Non-small Cell Lung Cancer. Front Genet 2022; 13:850290. [PMID: 35646096 PMCID: PMC9133843 DOI: 10.3389/fgene.2022.850290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The feasibility and value of pericardial effusion as a liquid biopsy sample for actionable alteration detection in patients with non-small cell lung cancer (NSCLC) has not been adequately investigated. Here, we aim to reveal genomic alterations between pericardial effusion and paired tumor tissue, plasma (plasma cfDNA), and pleural effusion supernatant (PE-cfDNA) based on second-generation sequencing technology. Material and methods: A total of 26 advanced NSCLC patients were retrospectively studied. The following samples were collected and sequenced using two targeted next-generation sequencing panels: pericardial effusion (n = 26), matched tumor tissue (n = 6), plasma (n = 16), and pleural effusion supernatant (n = 5). Results: A total of 10 actionable alterations were identified in pericardial effusion of the NSCLC patients, including MET amplification, EGFR L858R, EGFR T790M, EGFR exon 19 deletion, EGFR L861Q, KRAS G12C, EML4-ALK (exon 18: exon 20) fusion, EML4-ALK (exon 20: exon 20) fusion, EML4-ALK (exon 6: exon 20) fusion, and ERBB2 exon 20 insertion. All these actionable alterations harbored multiple drug-sensitive targets as well as several drug-resistant targets, such as EGFR T790M. Compared to plasma cfDNA of 16 patients, paired pericardial effusion had higher number of actionable alterations (p = 0.08) as well as higher percentage of the population with actionable alterations (p = 0.16). Moreover, 8 out of 10 actionable alterations with single nucleotide variations (SNVs) or insertions/deletions (indels) had a higher variant allele frequency (VAF) in pericardial effusion than plasma cfDNA. In addition, we identified two actionable alterations in paired pericardial effusion, which were absence in PE-cfDNA. Clearly, 2 out of 3 actionable alterations with SNVs/indels in pericardial effusion had a higher VAF than those in PE-cfDNA. Our finding suggested the importance of pericardial effusion in the optimal selection of patients for targeted therapy. Conclusion: Among liquid biopsy specimens from the advanced NSCLC patients, pericardial effusion may be a better candidate for genomic profiling than plasma cfDNA, while it could serve as a supplement to PE-cfDNA in detecting actionable alterations. Therefore, pericardial effusion might provide a new alternative for selection of patients for better treatment management.
Collapse
Affiliation(s)
- Jiaxue He
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Genetic Diagnosis Center, The First Hospital of Jilin University, Changchun, China
| | - Xintong Hu
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Genetic Diagnosis Center, The First Hospital of Jilin University, Changchun, China
| | - Liguo Chen
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Genetic Diagnosis Center, The First Hospital of Jilin University, Changchun, China
| | - Qiaoliang Liu
- College of Communication Engineering, Jilin University, Changchun, China
| | - Yanfang Jiang
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Genetic Diagnosis Center, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Yanfang Jiang,
| |
Collapse
|
19
|
Lazaros G, Lazarou E, Tsioufis P, Soulaidopoulos S, Iliakis P, Vlachopoulos C, Tsioufis C. Chronic pericardial effusion: current concepts and emerging trends. Expert Rev Cardiovasc Ther 2022; 20:363-376. [PMID: 35524164 DOI: 10.1080/14779072.2022.2075346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pericardial effusion (PEF) is a common and challenging pericardial syndrome with a variety of clinical manifestations ranging from asymptomatic, incidentally uncovered small PEFs, to life-threatening cardiac tamponade. AREAS COVERED : This review focuses on the pathophysiology, epidemiology, etiology, classification, clinical findings, diagnostic work-up, management and outcome of PEFs. Particular emphasis has been given on the most recent evidence concerning the contribution of imaging for the detection, differential diagnosis and evaluation of the hemodynamic impact of PEFs on the diastolic filling of the heart. Moreover, simplified algorithms for PEF triage and management have been included. EXPERT OPINION The management of patients with PEFs is mainly based on four parameters namely hemodynamic impact on diastolic function, elevation of inflammatory markers, presence of a specific underlying condition known to be associated with PEF and finally size and duration of the effusion. Novel data have contributed to change our view towards large, asymptomatic, "idiopathic" PEFs and dictated a rather conservative approach in most cases. It is also stressed that there is a compelling need for additional research, which is essential for tailored treatments aiming at the improvement of quality of life and containment of health care costs.
Collapse
Affiliation(s)
- George Lazaros
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Emilia Lazarou
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagιotis Iliakis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| |
Collapse
|
20
|
Iwasaki YK, Fujimoto Y, Ito-Hagiwara K, Oka E, Hayashi H, Kubota Y, Murata H, Yamamoto T, Miyachi H, Tara S, Tokita Y, Yodogawa K, Yamamoto T, Takano H, Shimizu W. Feasibility and safety of CT-aided pericardiocentesis from a subxiphoid anterior approach by using fluoroscopy in patients with chronic pericardial effusions. Clin Cardiol 2022; 45:519-526. [PMID: 35266157 PMCID: PMC9045084 DOI: 10.1002/clc.23810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/11/2022] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Pericardiocentesis is an essential procedure for the diagnosis and treatment of pericardial effusions. The purpose of this study was to evaluate the feasibility and safety of a subxiphoid anterior approach using fluoroscopy aided by a sagittal axis chest computed tomography (CT) view in comparison with an ultrasound‐guided apical approach in patients with chronic pericardial effusion. Methods Among 72 consecutive patients (68.8 ± 14.4 years old, 52 males) with hemodynamically stable chronic pericardial effusions, a total of 85 procedures were retrospectively analyzed. We divided them into two groups according to the site of the approach for the pericardiocentesis. Results A subxiphoid anterior approach (n = 53) was performed guided by fluoroscopy. The sagittal axis view of the chest CT was constructed to determine the puncture angle and direction for the subxiphoid anterior approach. An apical approach (n = 32) was performed by ultrasound guidance. The success rates of the anterior and apical approaches were 98.1% and 93.8%, respectively. There were two cases with cardiac perforations in the apical approach group, while no cases developed perforations in the subxiphoid anterior approach group. Conclusion The subxiphoid anterior approach for pericardiocentesis was feasible and safe for managing chronic pericardial effusions. A reconstruction of the sagittal axis view of the chest CT imaging was helpful to identify the direction and depth to access the pericardial space from the subxiphoid puncture site before the pericardiocentesis using the lateral fluoroscopic view.
Collapse
Affiliation(s)
- Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Eiichiro Oka
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hideki Miyachi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shuhei Tara
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yukichi Tokita
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Takeshi Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
21
|
Dessalegn N, Felux K, Seid E, Mohammed A. Primary Lung Adenocarcinoma Presenting as Cardiac Tamponade in a 40-Year-Old Non-Smoker. Cureus 2022; 14:e21631. [PMID: 35228977 PMCID: PMC8877732 DOI: 10.7759/cureus.21631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/05/2022] Open
|
22
|
Biomarkeri imagistici CT – indicii pentru etiologia epanşamentelor pericardice cu accent pe patologia tumorală. ONCOLOG-HEMATOLOG.RO 2022. [DOI: 10.26416/onhe.60.3.2022.7152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
23
|
Alizadeh B, Shaye Z, Badiea Z, Dehghanian P. Massive pericardial effusion as the first manifestation of childhood non-Hodgkin's lymphoma: A case report. Clin Case Rep 2021; 9:e05105. [PMID: 34853684 PMCID: PMC8614089 DOI: 10.1002/ccr3.5105] [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: 06/15/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 11/11/2022] Open
Abstract
Although one of the serious manifestations of advanced malignancies is pericardial involvement, pericardial involvement of lymphoma is extremely rare. We present a case of a 6-year-old girl arriving at the hospital with dyspnea and pleuritic chest pain, which is eventually diagnosed with massive pericardial effusion due to mediastinal non-Hodgkin lymphoma.
Collapse
Affiliation(s)
- Behzad Alizadeh
- Faculty of MedicineInterventional Pediatric Cardiology, Pediatric and Congenital Cardiology DivisionPediatric DepartmentImam Reza Training HospitalMashhad University of Medical SciencesMashhadIran
| | - Zahra Shaye
- Mashhad University of Medical SciencesMashhadIran
| | - Zahra Badiea
- Pediatric Hematology and OncologyMashhad University of Medical SciencesMashhadIran
| | - Paria Dehghanian
- Pediatric PathologistMashhad University of Medical SciencesMashhadIran
| |
Collapse
|
24
|
Gevaert SA, Halvorsen S, Sinnaeve PR, Sambola A, Gulati G, Lancellotti P, Van Der Meer P, Lyon AR, Farmakis D, Lee G, Boriani G, Wechalekar A, Okines A, Asteggiano R. Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Consensus Document of the Acute CardioVascular Care (ACVC) association and the ESC council of Cardio-Oncology-Part 1: acute coronary syndromes and acute pericardial diseases. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:947-959. [PMID: 34453829 DOI: 10.1093/ehjacc/zuab056] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/22/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Abstract
Advances in treatment, common cardiovascular (CV) risk factors and the ageing of the population have led to an increasing number of cancer patients presenting with acute CV diseases. These events may be related to the cancer itself or the cancer treatment. Acute cardiac care specialists must be aware of these acute CV complications and be able to manage them. This may require an individualized and multidisciplinary approach. We summarize the most common acute CV complications of cytotoxic, targeted, and immune-based therapies. This is followed by a proposal for a multidisciplinary approach where acute cardiologists work close together with the treating oncologists, haematologists, and radiation specialists, especially in situations where immediate therapeutic decisions are needed. In this first part, we further focus on the management of acute coronary syndromes and acute pericardial diseases in patients with cancer.
Collapse
Affiliation(s)
- Sofie A Gevaert
- Department of Cardiology, Ghent University Hospital, C Heymanslaan 10, 9000 Gent, Belgium
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Peter R Sinnaeve
- Department of Cardiology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Antonia Sambola
- Department of Cardiology, University Hospital Vall d'Hebron, Universitat Autonòma, CIBER-CV, Passeig de la Vall d'Hebron 119, 08035 Barcelona, Spain
| | - Geeta Gulati
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Science and Department of Cardiology, CHU Sart Tilman, Avenue del'Hôpital 1, 4000 Liège, Belgium
| | - Peter Van Der Meer
- Department of Cardiology, University of Groningen University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Alexander R Lyon
- Cardio-Oncology Clinic at Royal Brompton Hospital and Imperial College, Sydney street, SW3 6NP London, UK
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Agio Nikolaou street 93, 2408 Nicosia, Cyprus
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, Strand, WC2R 2LS London, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia and Policlinico Di Modena, Via Giuseppe Campi 287, 41125 Modena, Italy
| | - Ashutosh Wechalekar
- Department of Haematology, University College London/University College London Hospitals, Huntley street 72, WC1E 6DD London, UK
| | - Alicia Okines
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Fulham road 203, SW3 6JJ London, UK
| | - Riccardo Asteggiano
- Insubria University, Via Ravasi 2, 21100 Varese, Italy.,LARC (Laboratorio Analisi e Ricerca Clinica), Via Mombarcaro 80, 10136 Turin, Italy
| |
Collapse
|
25
|
Parthiban N, Sani H. Cardiac tamponade as the first presentation of thymoma: A case report during COVID-19 pandemic. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [PMCID: PMC9198665 DOI: 10.1177/20101058211048956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a case of neoplastic cardiac tamponade, a life-threatening condition, as the initial presentation of an anterior mediastinal malignancy. A 69-year-old gentleman with no known history of malignancy presented to the emergency department with shortness of breath, reduced effort tolerance and chronic cough. Clinically, he was not in distress but tachycardic. He was subjected to echocardiography which revealed large pericardial effusion with tamponade effect. Pericardiocentesis drained 1.5 L of haemoserous fluid. CECT thorax, abdomen and pelvis revealed an anterior mediastinal mass with intrathoracic extension complicated with mass effect onto the right atrium and mediastinal vessels. Ultrasound-guided biopsy histopathology examination revealed thymoma. Due to locally advanced disease, tumour resection was not possible, and patient was referred to oncology team for chemoradiotherapy. We report this case study not only due to the rarity of the case but also to highlight its diagnostic challenge due to the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Huzairi Sani
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| |
Collapse
|
26
|
Gong J, Drobni ZD, Zafar A, Quinaglia T, Hartmann S, Gilman HK, Raghu VK, Gongora C, Sise ME, Alvi RM, Zubiri L, Nohria A, Sullivan R, Reynolds KL, Zlotoff D, Neilan TG. Pericardial disease in patients treated with immune checkpoint inhibitors. J Immunother Cancer 2021; 9:jitc-2021-002771. [PMID: 34145031 PMCID: PMC8215235 DOI: 10.1136/jitc-2021-002771] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There are limited data on the occurrence, associations and outcomes of pericardial effusions and pericarditis on or after treatment with immune checkpoint inhibitors (ICIs). METHODS This was a retrospective study at a single academic center that compared 2842 consecutive patients who received ICIs with 2699 age- and cancer-type matched patients with metastatic disease who did not receive ICI. A pericardial event was defined as a composite outcome of pericarditis and new or worsening moderate or large pericardial effusion. The endpoints were obtained through chart review and were blindly adjudicated. To identify risk factors associated with a pericardial event, we compared patients who developed an event on an ICI with patients treated with an ICI who did not develop a pericardial event. Cox proportional-hazard model and logistical regression analysis were performed to study the association between ICI use and pericardial disease as well as pericardial disease and mortality. An additional 6-week landmark analysis was performed to account for lead-time bias. RESULTS There were 42 pericardial events in the patients treated with ICI (n=2842) over 193 days (IQR: 64-411), yielding an incidence rate of 1.57 events per 100 person-years. There was a more than fourfold increase in risk of pericarditis or a pericardial effusion among patients on an ICI compared with controls not treated with ICI after adjusting for potential confounders (HR 4.37, 95% CI 2.09 to 9.14, p<0.001). Patients who developed pericardial disease while on an ICI had a trend for increased all-cause mortality compared with patients who did not develop a pericardial event (HR 1.53, 95% CI 0.99 to 2.36, p=0.05). When comparing those who developed pericardial disease after ICI treatment with those who did not, a higher dose of corticosteroid pre-ICI (>0.7 mg/kg prednisone) was associated with increased risk of pericardial disease (HR 2.56, 95% CI 1.00 to 6.57, p=0.049). CONCLUSIONS ICI use was associated with an increased risk of development of pericardial disease among patients with cancer and a pericardial event on an ICI was associated with a trend towards increase in mortality.
Collapse
Affiliation(s)
- Jingyi Gong
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zsofia Dora Drobni
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Amna Zafar
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thiago Quinaglia
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Hartmann
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah K Gilman
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vineet K Raghu
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos Gongora
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raza M Alvi
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leyre Zubiri
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ryan Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Zlotoff
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Abstract
Despite the monumental advances in the diagnoses and therapeutics of malignancy, several cancer patients have presented with pericardial involvement, including acute pericarditis, constrictive pericarditis, and pericardial effusion. Multiple factors can contribute to acute pericarditis, including direct metastasis to the heart, pericardial hemorrhage, infections due to immunosuppression, and cancer therapies that include chemotherapy, immunotherapy, and radiation. Pericardial effusion, either due to cancer invasion or cancer treatment, is one of the most common incidental findings in cancer patients, which significantly worsens morbidity and mortality. If left untreated, pericardial effusion is known to cause complications such as pericardial tamponade. Constrictive pericarditis can be due to radiation exposure, chemotherapy, or is a sequela of a previous episode of acute pericarditis. In conclusion, early detection, prompt treatment, and understanding of pericardial diseases are necessary to help improve the quality of life of cancer patients, and we aim to summarize the knowledge of pericardial involvement in patients with cancer.
Collapse
|
28
|
Andreis A, Imazio M, Casula M, Avondo S, Brucato A. Recurrent pericarditis: an update on diagnosis and management. Intern Emerg Med 2021; 16:551-558. [PMID: 33641044 PMCID: PMC7914388 DOI: 10.1007/s11739-021-02639-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
Recurrent pericarditis is a true challenge for clinicians, especially when the patient becomes unresponsive or not tolerant to conventional treatments. An accurate diagnosis of recurrent pericarditis, possibly supported by advanced imaging tools, is critical to provide timely and appropriate treatment of symptoms and prevention of further episodes. The incessant research on the inflammatory pathways underlying cardiovascular diseases, led recently to the assessment of anti interleukin-1 agents in the setting of recurrent pericarditis. This review will focus on the diagnostic assessment of recurrent pericarditis, along with the most modern therapeutic advances in this field. Bibliographic databases were searched (MEDLINE/PubMed, BioMed Central, the Cochrane Collaboration Database of Randomized Trials, Scopus, ClinicalTrials.gov, EMBASE, Google Scholar) using the terms "recurrent pericarditis" AND "diagnosis" OR "treatment" OR "IL-1" OR "inflammation".
Collapse
Affiliation(s)
- Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città Della Salute E Della Scienza Di Torino Hospital, University of Torino, Corso Bramante 88, 10141, Torino, Italy
| | - Massimo Imazio
- Division of Cardiology, Department of Medical Sciences, Città Della Salute E Della Scienza Di Torino Hospital, University of Torino, Corso Bramante 88, 10141, Torino, Italy.
| | - Matteo Casula
- Division of Cardiology, Department of Medical Sciences, Città Della Salute E Della Scienza Di Torino Hospital, University of Torino, Corso Bramante 88, 10141, Torino, Italy
| | - Stefano Avondo
- Division of Cardiology, Department of Medical Sciences, Città Della Salute E Della Scienza Di Torino Hospital, University of Torino, Corso Bramante 88, 10141, Torino, Italy
| | | |
Collapse
|
29
|
Case study-based systematic review of literature on lymphoma-associated cardiac tamponade. Contemp Oncol (Pozn) 2021; 25:57-63. [PMID: 33911983 PMCID: PMC8063898 DOI: 10.5114/wo.2021.103828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/03/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compile all the relevant studies of patients presenting with pericardial tamponade before or after diagnosis of lymphoma, describe the clinical presentations of patients with lymphoma and cardiac tamponade, and assess the difference in overall survival based on the timing of cardiac tamponade diagnosis. A comprehensive search strategy was conducted in the following databases: PubMed and Cochrane Library, using the following keywords: Lymphoma AND Cardiac Tamponade. The criteria for eligibility included cases with a confirmed diagnosis of lymphoma and cardiac tamponade, human studies, and publications in English language. The statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20. We included 48 research articles (n = 52 cases) with adequate reporting of measured outcomes. The median age of the patients was 52 (9–94) years. Only 6 patients were noted to have primary cardiac lymphoma, while the majority of cases were considered to have secondary cardiac lymphoma (88.5%). According to the data on the type of lymphoma reported through cytology and immunohistochemistry, 49 patients were diagnosed with non-Hodgkin lymphoma, and of these cases the most common subtype was large B-cell lymphoma (42.9%). Overall, the average duration of illness was 14 ± 23 days. A total of 13 patients had distant heart sounds, 12 cases were noted to be hypotensive, and 13 subjects were found to have increased jugular venous pressure. Our retrospective study demonstrated that most patients presented with pericardial tamponade after lymphoma diagnosis, and those were mostly secondary cardiac lymphoma of the non-Hodgkin type with large B-cell as the most common subtype. Dyspnoea, oedema, and constitutional symptoms were the most common presenting signs. The median overall survival of patients with lymphoma and cardiac tamponade is 4 months, with no significant difference in mortality in the presentation timing before and after the diagnosis of lymphoma.
Collapse
|
30
|
Lazaros G, Vlachopoulos C, Lazarou E, Tousoulis D, Tsioufis C. Contemporary management of pericardial effusion. Panminerva Med 2021; 63:288-300. [PMID: 33393752 DOI: 10.23736/s0031-0808.20.04197-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericardial effusion is a relatively common clinical condition with a variety of clinical manifestations ranging from incidentally discovered asymptomatic cases to life-threatening cardiac tamponade. The etiology encompasses idiopathic cases and forms secondary to different conditions, including autoimmune diseases, malignancies, metabolic disorders, etc. While medical therapy should be offered to patients with elevation of inflammatory markers, in specific forms treatment should be appropriate to the underlying disorder. In cases with hemodynamic compromise pericardial drainage either with pericardiocentesis or pericardial "window" is indicated for therapeutic and diagnostic purposes. In the remainder, factors like comorbidities, size and location of the pericardial effusion will influence the clinical decision making. In asymptomatic or minimally symptomatic chronic large idiopathic pericardial effusions, according to recent evidence, a conservative approach with watchful waiting seems the most reasonable option. The prognosis of pericardial effusions largely depends on the underlying etiologies. Metastatic spread to the pericardium has an ominous prognosis whereas large to moderate effusions have been often associated with known or newly discovered specific underlying causes. Chronic small idiopathic effusions have an excellent prognosis and do not require specific monitoring. Large chronic idiopathic effusions in clinically stable patients require a 3 to 6-month assessment ideally in a specialized unit.
Collapse
Affiliation(s)
- George Lazaros
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece -
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
31
|
Pulmonary hypertension concurrent with pericardial effusion and superior vena cava syndrome: who is the initiator? J Geriatr Cardiol 2020; 17:723-727. [PMID: 33343651 PMCID: PMC7729177 DOI: 10.11909/j.issn.1671-5411.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
32
|
Mehmood MA, Bapna M, Siddiqa A, Haider A, Saad M. Hemorrhagic Pericardial Effusion Leading to Cardiac Tamponade: A Rare Initial Presentation of Adenocarcinoma of the Lung. Cureus 2020; 12:e11411. [PMID: 33312807 PMCID: PMC7725493 DOI: 10.7759/cureus.11411] [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] [Indexed: 11/05/2022] Open
Abstract
Malignancy associated pericardial effusion is a serious condition and testifies to poor prognosis. Cardiac tamponade can be the first presentation of underlying adenocarcinoma of the lung. We present a 78-year-old female with no known history of any malignancy, who presented with symptoms of abdominal and respiratory pathology. The physical exam findings were significant for a possible cardiac tamponade. Computed tomography (CT) of the abdomen and chest confirmed moderate bilateral pleural effusions, large pericardial effusion, left upper lobe mass, possible lymphangitic spread of carcinoma in the left lung, and adenopathy in the mediastinum. The echocardiography findings further confirmed tamponade. Cardiology and pulmonary medicine were taken on board for a possible malignancy associated pleural effusion leading to cardiac tamponade. Pericardial fluid analysis showed atypical cells suggestive of malignancy. Transbronchial biopsy confirmed moderately differentiated invasive adenocarcinoma. Positron emission tomography (PET) scan revealed metastatic spread to the mediastinum and right hilum with possible pleural metastatic disease seen posteriorly in the left hemithorax. The patient was discharged home with oncology follow up for chemotherapy.
Collapse
Affiliation(s)
| | - Monica Bapna
- Internal Medicine, BronxCare Hospital Center, Bronx, USA
| | - Ayesha Siddiqa
- Internal Medicine, BronxCare Hospital Center, Bronx, USA
| | - Asim Haider
- Internal Medicine, King Edward Medical University, Lahore, PAK.,Internal Medicine, BronxCare Hospital Center, Bronx, USA
| | | |
Collapse
|
33
|
Imazio M. Pericardiocentesis With Extended Drainage and Colchicine: New Indication for Malignant Pericardial Effusions? J Am Coll Cardiol 2020; 76:1562-1563. [PMID: 32972533 PMCID: PMC7505569 DOI: 10.1016/j.jacc.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
| |
Collapse
|
34
|
Effect of Anti-Inflammatory Drugs on Clinical Outcomes in Patients With Malignant Pericardial Effusion. J Am Coll Cardiol 2020; 76:1551-1561. [DOI: 10.1016/j.jacc.2020.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 01/15/2023]
|
35
|
Moursy S, Gaballa S, Ahmed A, Hlaing KM, Patel BB. Impending Cardiac Tamponade as the Initial Manifestation of BCR-ABL Positive Chronic Myeloid Leukemia. Cureus 2020; 12:e9631. [PMID: 32923232 PMCID: PMC7478927 DOI: 10.7759/cureus.9631] [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] [Indexed: 11/05/2022] Open
Abstract
Leukemia involves all organs and tissues of the body. Leukemic infiltration of the pericardium has been documented frequently at post-mortem examinations. Clinically, however, pericardial effusion with cardiac tamponade is rare, and only isolated case reports have been described. In all the reported cases, therapeutic pericardiocentesis was required for the relief of cardiac tamponade with the risk of bleeding since these patients often had deranged hemostasis. We are reporting a rare case of hemorrhagic pericardial effusion in chronic myeloid leukemia before starting the tyrosine kinase inhibitors. The patient required therapeutic pericardiocentesis and hydroxyurea treatment.
Collapse
Affiliation(s)
- Safa Moursy
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | | | - Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Brijesh B Patel
- Internal Medicine/Pulmonary and Critical Care, LewisGale Medical Center, Salem, USA
| |
Collapse
|
36
|
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|