Multimodality imaging in the evaluation of cardiovascular manifestations of malignancy

Direct Left Ventricular Metastasis Reduction: 3D-Echo Monitoring For Management of Clinical Case

A 52-year-old woman with a lung carcinoma metastatic to bone was admitted to the Cardiology Department for acute chest pain after 1 week of the oncologic therapy. Electrocardiographic examination (ECG) revealed ischemic picture with ST-T wave abnormalities in DI and aVL leads and poor progression of R wave in V1-V4 leads. Two- and three-dimensional transthoracic echocardiography (2D/3D TTE) showed myocardial involvement with infiltration of the anterolateral left ventricular (LV) wall from the epicardial to the endocardial layer, apical hypokinesia, LV ejection fraction (LVEF) and global 3D longitudinal strain reduction, but was absent pericardial effusion. Three months from the beginning of erlotinib, the patient showed a significant reduction in myocardial involvement with no ECG-ST elevation. Echo showed a mild regression of the wall infiltration and a slightly improvement of LVEF and strain. A computed tomography (CT) scan showed partial remission of the primary lung lesion, intracavitary and intramyocardial mass.