Gemcitabine induced cardiomyopathy: a case of multiple hit cardiotoxicity

Abstract Gemcitabine is a commonly used antineoplastic agent used to treat a variety of cancers with rarely reported cardiac side effects. We describe a case of a 67‐year‐old woman with follicular lymphoma who experienced a rarely reported side effect of gemcitabine: cardiomyopathy. This case highlights a multiple hit mechanism of myocyte damage that may occur following the use of multiple cardio‐toxic agents despite their administration in doses not associated with cardiotoxicity

Honors Bachelor of Science

thesisCardiovascular disease is the leading cause of death in the U.S. and Utah for both genders, and all racial and ethnic groups. Although many risk factors exist for cardiovascular disease, elevated total serum cholesterol levels are a major modifiable risk factor. Low income populations who have little access to health care face continual challenges in the form of environmental, social, and psychological barriers. Consequently, they are increasingly susceptible to the development of unmonitored high serum cholesterol levels and the subsequent risk of cardiovascular disease. The purpose of this study was to explore and examine the relationship between cholesterol level and socio-demographic variables, in order to work towards better prevention and screening in this population. Data was collected from the Maliheh Free Clinic located in Salt Lake City, Utah that offers health care to an underserved population who do not qualify for Medicaid or Medicare. A total of 226 patient charts were reviewed to collect data on patient characteristics and socioeconomic variables. Descriptive statistics such as chi square, T-tests, and ANOVA were performed to analyze the data. Total serum cholesterol among patients increased with age (p=.05). Mean total serum cholesterol decreased as income level increased among our sample. A higher percentage of patients in unemployed (14.0%) or unknown income (15.9%) categories were at highrisk (>= 240 mg/dL) compared to patients who had some monthly income. A higher percentage of male patients were found to be in the high risk category for total serum cholesterol level compared to female patients (13.6% vs. 11.8%). These findings allow a better understanding of the particular risks associated with serum cholesterol levels in this population. This information can be used to provide better preventative care, screening, and health education workshops to prevent cardiovascular disease in a culturally appropriate manner that meets the specific needs of this low-income population

Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Abstract Aims We sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM). Methods and results We conducted a multi‐centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization. RV function was obtained from echocardiogram reports. In total, 229 women (1993–2017) met criteria for PPCM. Mean age was 32.4 ± 6.8 years, 28% were of African descent, 50 (22%) had RV dysfunction, and 38 (17%) had PASP ≥ 30 mmHg. After a median follow‐up of 3.4 years (interquartile range 1.0–8.8), 58 (25%) experienced the composite outcome of adverse events. African descent, family history of cardiomyopathy, LVEF, and PASP were significant predictors of RV dysfunction. Using Cox proportional hazards models, we found that women with RV dysfunction were three times more likely to experience the adverse composite outcome: hazard ratio 3.21 (95% confidence interval: 1.11–9.28), P = 0.03, in a multivariable model adjusting for age, race, body mass index, preeclampsia, hypertension, diabetes, kidney disease, and LVEF. Women with PASP ≥ 30 mmHg had a lower probability of survival free from adverse events (log‐rank P = 0.04). Conclusions African descent and family history of cardiomyopathy were significant predictors of RV dysfunction. RV dysfunction and elevated PASP were significantly associated with a composite of major adverse cardiac events. This at‐risk group may prompt closer monitoring or early referral for advanced therapies

Ideal Cardiovascular Health, Cardiovascular Remodeling, and Heart Failure in Blacks: The Jackson Heart Study.

BACKGROUND: The lifetime risk of heart failure is higher in the African-American population than in other racial groups in the United States. METHODS AND RESULTS: We measured the Life’s Simple 7 ideal cardiovascular health metrics in 4195 African-Americans in the Jackson Heart Study (2000–2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular (LV) structure and function by cardiac magnetic resonance (CMR; n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0–2 Simple 7 factors, African-Americans with 3 factors had 47% lower incident HF risk (HR 0.53, 95% CI 0.39–0.73, P<0.0001); those with ≥ 4 factors had 61% lower HF risk (HR 0.39, 95% CI 0.24–0.64, P=0.0002). Higher blood pressure (HR 2.32, 95% CI 1.28–4.20, P=0.005), physical inactivity (HR 1.65, 95% CI 1.07–2.55, P=0.02), smoking (HR 2.04, 95% CI 1.43–2.91, P<0.0001) and impaired glucose control (HR 1.76, 95% CI 1.34–2.29, P<0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and non-smoking was associated with less likelihood of adverse cardiac remodeling by CMR. CONCLUSIONS: Cardiovascular risk factors in mid-life (specifically elevated blood pressure, physical inactivity, smoking and poor glucose control) are associated with incident HF in African Americans, and represent targets for intensified HF prevention