1
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Nowatzke J, Guedeney P, Palaskas N, Lehmann L, Ederhy S, Cautela J, Francis S, Courand PY, Aras M, Arangalage D, Fenioux C, Finke D, Huang S, Moslehi J, Salem JE. Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis – report from an international registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Immune-checkpoint-blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis.
Methods
An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence of coronary artery disease (CAD) was defined as coronary artery stenosis >70% in patients undergoing coronary angiogram.
Results
Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary angiography, CAD was present in 59/261 (22.6%) (Table 1). Coronary revascularization was performed during the index hospitalization in 19/59 (32.2%) patients. Patients undergoing coronary revascularization less frequently received steroids administration within 24h of admission compared to the other groups (p=0.029). Myocarditis related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 5/31 (16.1%) in those not revascularized and 25/156 (16.0%) in those without CAD (p=0.001). irAE-related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 6/31 (19.4%) in those not revascularized and 31/156 (19.9%) in no CAD groups (p=0.007) (Figure 1). All-cause 90-day mortality was 11/17 (64.7%) in the revascularized cohort, compared to 13/31 (41.9%) in no revascularization and 60/158 (38.0%) in no CAD groups (p=0.10). After adjustment on age and sex, coronary revascularization remained associated with ICB-myocarditis-related death at 90 days (Hazard ratio [HR]=4.03, 95%confidence interval [CI] 1.84–8.84, p<0.001) and was marginally associated with all-cause death (HR=1.88, 95% CI 0.98–3.61, p=0.057).
Conclusion
CAD may exist concomitantly with ICB-myocarditis and portend a poorer outcome when revascularization is performed. This is potentially mediated thru delayed diagnosis and treatment or more severe presentation of ICB-myocarditis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Nowatzke
- Vanderbilt University Medical Center, Department of internal medicine , Nashville , United States of America
| | - P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - N Palaskas
- The University of Texas Medical School, Department of cardiology , Houston , United States of America
| | - L Lehmann
- University Hospital of Heidelberg, Department of cardiology , Heidelberg , Germany
| | - S Ederhy
- Hospital Saint-Antoine, Department of cardiology , Paris , France
| | - J Cautela
- Hospital Nord of Marseille, Department of cardiology , Marseille , France
| | - S Francis
- Maine Medical Center, Cardiovascular disease service line , Portland , United States of America
| | - P Y Courand
- Croix-Rousse Hospital - HCL, Fédération de cardiologie , Lyon , France
| | - M Aras
- University of California San Francisco, Division of cardiology , San Francisco , United States of America
| | - D Arangalage
- Bichat APHP Site of Paris Nord University Hospital, Department of cardiology , Paris , France
| | - C Fenioux
- Hospital Pitie-Salpetriere, Department of Pharmacology and Clinical Investigation Centre , Paris , France
| | - D Finke
- University Hospital of Heidelberg, Department of cardiology , Heidelberg , Germany
| | - S Huang
- Vanderbilt University Medical Center, Department of internal medicine , Nashville , United States of America
| | - J Moslehi
- University of California San Francisco, Division of cardiology , San Francisco , United States of America
| | - J E Salem
- Hospital Pitie-Salpetriere, Department of Pharmacology and Clinical Investigation Centre , Paris , France
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2
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Pavon A, Guglielmo M, Arangalage D, Bonanni M, Angelini G, Paiocchi V, Leo L, Valgimigli M, Pedrazzini G, Pontone G, Monney P, Faletra F. Additional value of CMR feature tracking parameters for the evaluation of the risk of complex ventricular arrhythmias and sudden cardiac death in patients with Mitral Valve Prolapse. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Mitral valve prolapse (MVP) with mitro-annular disjunction (MAD) has been associated with complex ventricular arrhythmias (c-VA) and sudden cardiac death (SCD) but risk stratification in this subset of patients remains insufficiently characterized. The aim of this study was to investigate the association between deformation parameters assessed by feature tracking (FT) cardiac magnetic resonance (CMR) in patients with MVP and MAD (MVP-MAD) and c-VA and/or SCD.
Methods
We included 23 patients (47 ± 13 years; 43 % males) with MVP-MAD, of whom 17 (74 %) presented with c-VA and 6 (26%) with SCD, as well as 20 age- and sex-matched controls (50 ± 18 years; 57% males). All patients underwent CMR with assessment of MAD length, late gadolinium enhancement (LGE), extracellular volume (ECV), global and regional longitudinal (LS), and circumferential strain (CS). RATIO-CS was defined as the ratio between regional CS in the basal inferolateral and mid-inferolateral walls (fig.1).
Results
In MVP-MAD patients, non-ischemic LGE of the LV inferior and inferolateral wall was observed in 21 patients (50%). As compared to controls, MVP-MAD patients showed lower global LS (-18.7 ±4.1 vs -24.7 ± 5.7 p < 0.001), higher native T1 relaxation time and ECV of the left ventricle (LV) inferolateral wall (1104 ± 63ms vs 1083 ± 66ms p < 0.029 and 0.31 ± 0.03 vs 0.27 ± 0.04 p 0.003), lower CS and LS of the LV mid and inferolateral segments (p < 0.005).
Logistic univariate regression analysis showed an increased risk of c-VA in case of LGE presence (OR: 9.52 [2.28-39.7] p = 0.002), a high number of LV segments with LGE (OR: 1.78 [1.21-2.63] p = 0.004), GLS (OR: 1.58 [1.21-2.07] p < 0.001), decreased inferolateral mid ventricular wall CS (OR: 1.41 [1.16-1.72] p < 0.001), decreased basal and mid-ventricular inferolateral wall LS (OR: 1.11 [1.00-1.23] p = 0.047 and OR: 1.62 [1.22-2.13] p < 0.001 respectively), increased native T1 times (OR: 1.01 [1.00-1.02] p = 0.039), increased ECV of the basal infero-lateral wall (OR: 4.93e + 07 [1.22-1.98e + 15] p = 0.047) and decreased RATIO-CS (OR: 7.48 [1.87-30.00] p = 0.005) (table 1). In multivariate analysis the presence of a lower LS in the basal inferolateral wall remained an independent predictor of c-VA (OR: 1.62 [1.22-2.13.00] p = 0.0007) and RATIO-CS remained an independent predictor of SCD (OR: 7.73 [1.78-33.60] p = 0.006).
Conclusion
Lower inferolateral LS and RATIO CS are respectively associated with c-VA and SCD in MVP-MAD patients. FT may provide additional value for risk stratification on top of standard CMR parameters in this subset of patients. Abstract Figure. fig.1 Abstract table 1
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Affiliation(s)
- A Pavon
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - M Guglielmo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Arangalage
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | - M Bonanni
- University of Rome Tor Vergata, tor, Rome, Italy
| | | | - V Paiocchi
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - L Leo
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - M Valgimigli
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - G Pontone
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - F Faletra
- Cardiocentro Ticino Foundation, Lugano, Switzerland
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3
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Pavon A, Arangalage D, Hugelshofer S, Rutz T, Porretta AP, Le Bloa M, Muller O, Pruvot E, Schwitter J, Monney P. Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In MVP, MAD has been associated with myocardial replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown. We aimed to evaluate the relationship between mitral annular disjunction (MAD) severity and myocardial interstitial fibrosis at the left ventricular (LV) base in patients with mitral valve prolapse (MVP), and to assess the association between severity of interstitial fibrosis and the occurrence of ventricular arrhythmic events
Methods
Thirty patients with MVP and MAD (MVP-MAD) underwent Cardiac Magnetic Resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECV). The control group included 14 patients with mitral regurgitation but no MAD (MR-NoMAD) and 10 patients with normal CMR (NoMR-NoMAD). Fifteen MVP-MAD patients underwent 24h-Holter monitoring.
Results
LGE was observed in 47% of MVP-MAD patients and absent in controls. ECV was higher in MVP-MAD (30 ± 3% vs 24 ± 3% MR-NoMAD, p < 0.0001 and vs 24 ± 2% NoMR-NoMAD, p < 0.0001), even in MVP-MAD patients without LGE (29 ± 3% vs 24 ± 3%, p < 0.0001 and vs 24 ± 2%, p < 0.0001, respectively), Fig.1. MAD length was correlated with ECV (rho = 0.61, p = 0.0003), but not with LGE extent. Four patients had history of OHCA; LGE and ECV were equally performant to identify those high-risk patients (area under the ROC curve 0.81 vs 0.83, p = 0.84). Among patients with Holter, 87% had complex ventricular arrhythmia. ECV was above the cut-off value in all while only 53% had LGE.
Conclusion
Increase in ECV, a marker of interstitial fibrosis, occurs in MVP-MAD even in the absence of LGE, and was correlated with MAD length and OHCA. ECV should be part of the CMR examination of MVP patients in an effort to better assess fibrous remodelling as it may provide additional value beyond the assessment of LGE in the arrhythmic risk stratification.
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Affiliation(s)
- A Pavon
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - D Arangalage
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - S Hugelshofer
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - T Rutz
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - AP Porretta
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - M Le Bloa
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - E Pruvot
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
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4
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Pavon A, Porretta AP, Arangalage D, Rutz T, Hugelshofer S, Domenichini G, Pruvot E, Muller O, Monney P, Pascale P, Schwitter J. Feasibility and prognostic value of adenosine stress perfusion cardiovascular magnetic resonance in patient with implantable device. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
stress CMR has a limited use in patients with implantable device, in order to the possible artefacts due to the metallic component and to the risk of adenosine interaction with cardiac pacing. The aim of the study was to assess the global feasibility and to assess the prognostic value of stress perfusion CMR in patients with implantable device.
Materials and Methods
we conducted a retrospective single-center longitudinal analysis of consecutive patients with an implantable device referred for stress CMR, performed using a 1.5 Tesla unit (Siemens Healthcare,MAGNETOM Aera, Erlangen-Germany). Protocol was adapted according to current guidelines. Cardiac follow-up [6 months to 7 years] was obtained by medical records of direct contact with patient’s cardiologist referral.
Results
44 patients were enrolled. 34 patients needed a continuous pacing during adenosine stress, that was settled in DOO in 14 (32%) and in VOO in 20 (45%). Device integrity was not compromised by CMR and not competitive atrial or ventricular stimulation was observed during examination. Image quality was good in 95% cases. 26% cases had a perfusion deficit corresponding to a previous scar, while 12% of patients had a positive stress test. All of them needed continuous pacing during stress test and underwent to a coronary angiography who confirmed the coronary stenosis. In patients without inducible ischemia 2 patients experienced a Non-ST-elevation Myocardial Infarction after 6 and 2 years while no other cardiac symptoms or cardiac hospitalisation was remarkable during follow up.
Conclusion
adenosine stress CMR in patient who are pacemaker dependent during scanner is feasible, with an overall good image quality, proving an excellent diagnostic and prognostic value in a long term follow up even. Adenosine administration is safe and no the magnetic field interference with the correct functioning of the device have been shown in short or long term follow-up.
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Affiliation(s)
- A Pavon
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - AP Porretta
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - D Arangalage
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - T Rutz
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - S Hugelshofer
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - G Domenichini
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - E Pruvot
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Pascale
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
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5
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Pavon A, Chautems C, Odin Y, Arangalage D, Rutz T, Hugelshofer S, Monney P, Schwitter J. Overcoming claustrophobia in cardiovascular magnetic resonance with medical hypnosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
the role of Cardiovascular Magnetic Resonance has gained the more and more importance in the field of cardiovascular disease. Claustrophobia remains a frequent cause of failure to complete a CMR. It is estimated that 2 million scans worldwide cannot be performed annually either due to premature termination or refusal of the patient to be scanned due to claustrophobia. In this setting, medical hypnosis may prove useful to overcome this main limitation.
Methods
we propose an observational study of consecutive patients referred to CMR and known for severe claustrophobia. Patients were proposed to undergo CMR examination with the help of medical hypnosis according to Milton H. Erickson’s method or with administration of mild sedation (lorazepam 2.5 mg).
Results
20 severe claustrophobic patients were considered in the study. 1 patient was excluded due to psychiatric condition, 1 patient undergo to general anesthesia, 5 patients refused the examination. Among the 13 patients, 10 underwent medical hypnosis while 3 patients accepted to undergo to CMR examination with the administration of lorazepam 2.5 mg. All patients treated with medical hypnosis were able to complete the examination with a great tolerance and no sign of stress or anxiety were reported. CMR protocol was performed according to clinical request and was not different form non-claustrophobic patients. None of the patients treated with lorazepam 2.5mg was able to complete the exam.
Conclusion
we prove medical hypnosis to be safe and effective in controlling patients’ anxiety, allowing optimal diagnostic imaging quality without the need to adapt the examination. Further studies in larger populations are needed to confirm our results.
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Affiliation(s)
- A Pavon
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - C Chautems
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - Y Odin
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - D Arangalage
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - T Rutz
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - S Hugelshofer
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
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6
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Arangalage D, Pavon AG, Hugelshofer S, Rutz T, Muller O, Schwitter J, Monney P. Myocardial interstitial fibrosis assessed by extracellular volume quantification is a determinant of symptoms in aortic valve regurgitation with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
According to current guidelines indication for surgery is straightforward with a class I recommendation in case of severe symptomatic aortic regurgitation (AR) and/or left ventricular ejection fraction (LVEF) decrease ≤50%. However, the management of patients with asymptomatic severe AR with preserved LVEF remains debated, with a cruel lack of prognostic factors to identify patients who may benefit from early intervention. An explanation to the absence of such factors is that the determinants of symptoms, a strong prognostic parameter, have been poorly identified. Beyond LV dilation and systolic dysfunction, which are both recognized prognostic factors in chronic AR, we hypothesized that interstitial myocardial fibrosis, as an early indicator of LV remodeling, may also influence the occurrence of symptoms. Cardiovascular magnetic resonance (CMR)-based myocardial extracellular volume (ECV) quantification by T1 mapping has emerged as a valuable tool to quantify diffuse myocardial fibrosis.
Objective
To study the relationship between myocardial interstitial fibrosis quantified by T1 mapping and the symptomatic status of patients with chronic aortic valve regurgitation.
Methods
We retrospectively included 38 consecutive patients with chronic, isolated, mild to severe AR who underwent a CMR at our institution. Exclusion criteria were the presence of any other heart condition that may induce myocardial fibrosis, ≥ mild associated valve disease, AR secondary to endocarditis, genetic, inflammatory or congenital disease except bicuspid aortic valve. T1 mapping of the basal segments was performed before and after contrast administration measuring native and post-contrast T1 relaxation time and ECV.
Results
Mean age was 56 ± 20 years, 30 patients (79%) were males, and symptoms were reported in 11 patients (29%). Mean LVEF was 57 ± 9% and ≥50% in 30 patients (79%). Aortic valve regurgitation fraction (RF) was 25 ± 13%, ECV 0.27 ± 0.04%, indexed LV end-diastolic volume (LVEDVi) 98 ± 32 ml/m2, end-systolic volume (LVESVi) 46 ± 19 ml/m2, and LV mass 79 ± 21 g/m2. LVESVi (r = 0.41,p = 0.01), LVEF (r=-0.59,p = 0.0001), and ECV (r = 0.42,p = 0.008) were correlated with symptoms, whereas age (r = 0.16,p = 0.33), gender (r=-0.24,p = 0.15), LVEDVi (r = 0.28,p = 0.09), LV mass index (r = 0.08,p = 0.62), and RF (r = 0.31,p = 0.06) were not. In the subgroup of patients with preserved LVEF (≥50%), after adjustment for LVESVi and RF, only ECV remained independently associated with symptoms (p = 0.046). Interestingly, when including the patients with a reduced LVEF < 50% in the multivariable analysis only LVESVi was an independent determinant of symptoms (p = 0.04) and ECV was not (p = 0.07)
Conclusion
myocardial fibrosis quantified by ECV calculation is a determinant of symptoms in AR with preserved LVEF. Further studies are warranted to determine the prognostic value of ECV that may justify earlier intervention.
Abstract Figure. ECV in AR with preserved LVEF
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Affiliation(s)
- D Arangalage
- University Hospital Centre Vaudois (CHUV), Department of Cardiology, Lausanne, Switzerland
| | - AG Pavon
- University Hospital Centre Vaudois (CHUV), Center for Cardiac Magnetic Resonance, Lausanne, Switzerland
| | - S Hugelshofer
- University Hospital Centre Vaudois (CHUV), Department of Cardiology, Lausanne, Switzerland
| | - T Rutz
- University Hospital Centre Vaudois (CHUV), Department of Cardiology, Lausanne, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Department of Cardiology, Lausanne, Switzerland
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), Center for Cardiac Magnetic Resonance, Lausanne, Switzerland
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Department of Cardiology, Lausanne, Switzerland
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7
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Haddad N, Vidal-Trecan T, Baroudjian B, Zagdanski AM, Arangalage D, Battistella M, Gautier JF, Lebbe C, Delyon J. Acquired generalized lipodystrophy under immune checkpoint inhibition. Br J Dermatol 2019; 182:477-480. [PMID: 31077337 DOI: 10.1111/bjd.18124] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 01/10/2023]
Abstract
Immune checkpoint inhibitors are now the standard of care in the treatment of several types of cancer. Cutaneous immune-related adverse events (irAEs) are usually of low grade and reversible, while endocrine irAEs are generally irreversible and managed with hormone replacement therapy. We report a 47-year-old patient, treated with the anti-programmed cell death (PD)1 antibody pembrolizumab for a metastatic melanoma, who developed severe lipodystrophy after 10 months of treatment, characterized by the loss of subcutaneous fat tissue, central obesity and insulin resistance with a decreased leptin level. Histological analysis of a cutaneous biopsy revealed subcutaneous fat cell destruction associated with oedema, the presence of lipophages, and a CD3+ lymphocytic infiltrate involving the panniculus. This led to the diagnosis of anti-PD-1-induced acquired generalized lipodystrophy, after ruling out differential diagnoses (i.e. genetic and systemic autoimmune diseases). No corticosteroids were introduced considering the high risk of inducing severe metabolic complications, and pembrolizumab was discontinued as complete response of the melanoma was achieved. However, after 12 months of follow-up, lipodystrophy and its severe metabolic complications are still ongoing. What's already known about this topic? Anti-programmed cell death (PD)1 agents are now a standard of care in the treatment of several cancers, including melanoma. Endocrine and cutaneous immune-related adverse events (irAEs) are among the most frequent irAEs (14-30% and 30-40%, respectively) in patients treated with immune checkpoint inhibitors. What does this study add? Acquired generalized lipodystrophy can occur during anti-PD1 therapy and is associated with severe metabolic complications. With the increase in anti-PD1 prescription in several cancer types, clinicians must be aware of the whole range of irAEs that may occur.
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Affiliation(s)
- N Haddad
- Department of Dermatology, AP-HP Saint-Louis Hospital, F-75010, Paris, France
| | - T Vidal-Trecan
- Department of Endocrinology, AP-HP Lariboisière Hospital, F-75010, Paris, France
| | - B Baroudjian
- Department of Dermatology, AP-HP Saint-Louis Hospital, F-75010, Paris, France
| | - A-M Zagdanski
- Department of Radiology, AP-HP Saint-Louis Hospital, F-75010, Paris, France.,Université de Paris, Paris, France
| | - D Arangalage
- Department of Cardiology, AP-HP Bichat Hospital, F-75018, Paris, France.,Université de Paris, INSERM U1148, F-75018, Paris, France
| | - M Battistella
- Department of Pathology, AP-HP Saint-Louis Hospital, F-75010, Paris, France.,Université de Paris, INSERM U1165, F-75010, Paris, France
| | - J-F Gautier
- Department of Endocrinology, AP-HP Lariboisière Hospital, F-75010, Paris, France.,Université de Paris, Paris, France
| | - C Lebbe
- Department of Dermatology, AP-HP Saint-Louis Hospital, F-75010, Paris, France.,Université de Paris, INSERM U976, HIPI équipe-1, F-75010, Paris, France
| | - J Delyon
- Department of Dermatology, AP-HP Saint-Louis Hospital, F-75010, Paris, France.,Université de Paris, INSERM U976, HIPI équipe-1, F-75010, Paris, France
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Chong-Nguyen C, Kerneis C, Matthieu T, Arangalage D, Juliard J, Aubry P, Abtan J, Brochet E. One-year experience of the micro trans esophageal probe in cardiac structural interventions. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Roger A, Lorillon G, Groh M, Lependu C, Maillet J, Arangalage D, Tazi A, Lebbe C, Baroudjian B, Delyon J. Granulomatose à éosinophiles avec polyangéite induite par des inhibiteurs du checkpoint immunitaire : un premier cas. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Dreyfus J, Ghalem N, Garbarz E, Cimadevilla C, Arangalage D, Verdonk C, Nguyen V, Vahanian A, Caranhac G, Messika-Zeitoun D. 1286Isolated tricuspid valve surgery - Early and midterm outcome from French nationwide database and local registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Zarka S, Bouleti C, Arangalage D, Chopra H, Steg P, Vahanian A, Laissy J, Ou P. Subepicardial hyperemia on contrast-enhanced first-pass magnetic resonance perfusion imaging is useful for the diagnosis of acute myocarditis. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Montoro Lopez M, Pons De Antonio I, Itziar Soto C, Florez Gomez R, Alonso Ladreda A, Rios Blanco J, Refoyo Salicio E, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, Van De Heyning CM, Magne J, Pierard L, Bruyere P, Davin L, De Maeyer C, Paelinck B, Vrints C, Lancellotti P, Michalski B, Krzeminska-Pakula M, Lipiec P, Szymczyk E, Chrzanowski L, Kasprzak J, Leao RN, Florencio AF, Oliveira AR, Bento B, Lopes S, Calaca J, Palma Reis R, Krestjyaninov M, Gimaev R, Razin V, Arangalage D, Chiampan A, Cimadevilla C, Touati A, Himbert D, Brochet E, Iung B, Nataf P, Vahanian A, Messika-Zeitoun D, Guvenc T, Karacimen D, Erer H, Ilhan E, Sayar N, Karakus G, Eren M, Iriart X, Tafer N, Roubertie F, Mauriat P, Thambo J, Wang J, Fang F, Yip GW, Sanderson J, Feng W, Yu C, Lam Y, Assabiny A, Apor A, Nagy A, Vago H, Toth A, Merkely B, Kovacs A, Castaldi B, Vida V, Guariento A, Padalino M, Cerutti A, Maschietto N, Biffanti R, Reffo E, Stellin G, Milanesi O, Baronaite-Dudoniene K, Urbaite L, Smalinskas V, Veisaite R, Vasylius T, Vaskelyte J, Puodziukynas A, Wieczorek J, Rybicka-Musialik A, Berger-Kucza A, Hoffmann A, Wnuk-Wojnar A, Mizia-Stec K, Melao F, Ribeiro V, Amorim S, Araujo C, Torres J, Cardoso J, Pinho P, Maciel M, Storsten P, Eriksen M, Boe E, Estensen M, Erikssen G, Smiseth O, Skulstad H, Miglioranza M, Gargani L, Sant`Anna R, Rover M, Martins V, Mantovanni A, Kalil R, Leiria T, Luo X, Fang F, Lee P, Zhang Z, Lam Y, Sanderson J, Kwong JS, Yu C, Borowiec A, Dabrowski R, Wozniak J, Jasek S, Chwyczko T, Kowalik I, Janas J, Musiej-Nowakowska E, Szwed H, Palinsky M, Petrovicova J, Pirscova M, Baricevic Z, Lovric D, Cikes M, Skoric B, Ljubas Macek J, Reskovic Luksic V, Separovic Hanzevacki J, Milicic D, Elmissiri A, El Shahid G, Abdal-Wahhab S, Vural MG, Yilmaz M, Cetin S, Akdemir R, Yoldas TK, Yeter E, Karamanou A, Hamodraka E, Lekakis I, Paraskevaidis I, Kremastinos D, Appiah-Dwomoh EK, Wang V, Otto C, Mayar F, Bonaventura K, Sunman H, Canpolat U, Kuyumcu M, Yorgun H, Sahiner L, Ozer N. Club 35 Poster Session Wednesday 11 December: 11/12/2013, 09:30-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hammoudi N, Arangalage D, Boubrit L, Renaud MC, Isnard R, Cohen A, Duguet A. Ultrasound based teaching of cardiac anatomy and physiology to undergraduate medical students. Arch Cardiovasc Dis 2013. [DOI: 10.1016/j.acvd.2013.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Van Der Vynckt C, Joffre J, Lang S, Ederhy S, Arangalage D, Haddour N, Soulat-Dufour L, Adavane S, Boccara F, Cohen A. Echocardiographic predictors of cardiovascular events in a population of subjects aged over 65years: Preliminary results. Arch Cardiovasc Dis 2013. [DOI: 10.1016/j.acvd.2013.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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