Non-invasive cardiac imaging for evaluation of cardiotoxicity in cancer patients - early detection and follow-up

Cardiotoxicity is an increasingly important clinical entity that occurs as a result of untoward, and incompletely understood, effects on cardiac function. It is primarily caused by the anthracycline agents (doxorubicin, daunorubicin) but has also been observed with monoclonal antibody agents such as trastuzumab and small molecule tyrosine kinase inhibitors. The most feared net result of these agents is left ventricular (LV) dysfunction resulting in symptomatic congestive heart failure (CHF). Other manifestations can include arrhythmias, pericardial constriction, valvulopathy and hypertension. Standard cardiac imaging techniques have largely focused on LV ejection fraction (LVEF) quantifi cation. Contemporary cardiac imaging technologies now exist that are capable of evaluating for and detecting earlier stages of cardiotoxicity, including those which occur prior to changes in LVEF. Therapeutic algorithms have been devised to tailor chemotherapeutic regimens based on these results and have resulted in a dramatically reduced incidence of overt CHF

Stress-induced cardiomyopathy complicating severe babesiosis

A post-menopausal lady with severe babesiosis developed a basal-type stress-induced cardiomyopathy. Left ventricular function normalized at three months. We believe this is the first reported case of stress cardiomyopathy complicating severe babesiosis. Cardiac biomarker elevation disproportionate to the area of myocardial dysfunction, electrocardiographic changes, the patient’s clinical condition, and close follow-up of left ventricular function parameters are all vital in diagnosing stress cardiomyopathy and may exclude the need for coronary angiography. There may be a possible association between severe babesiosis and stress cardiomyopathy. (Cardiol J 2011; 18, 1: 83-86

The common apolipoprotein A-1 polymorphism −75A>G is associated with ethnic differences in recurrent coronary events after recovery from an acute myocardial infarction

Since data regarding the relationship between a common polymorphism (SNP) of the apoA1 gene with apoA1 levels and risk of coronary artery disease are inconsistent, we hypothesized that its association with recurrent coronary events differs for White and Black individuals with diagnosed coronary heart disease. The apoA1 −75G>A SNP was genotyped in a cohort of 834 Black (n=129) and White (n=705) post-myocardial infarction patients. Recurrent coronary events (coronary-related death, non-fatal myocardial infarction, or unstable angina) were documented during an average follow-up of 28 months. Thirty percent of White and 21% of Black patients carried the SNP. Cox proportional-hazards regression analysis, adjusting for clinical and laboratory covariates, demonstrated that the SNP was not associated with recurrent events in the total cohort (HR=1.37, 95% CI 0.95–1.97; p= 0.09) but was the only variable associated with an increased risk of recurrent cardiac events in Blacks (HR=2.40, 95% CI 1.07–5.40; p= 0.034). Conversely in Whites, the SNP was not associated with recurrent events (HR=1.12, 95% CI 0.75–1.67; p= 0.59) whereas apoB (HR=1.78, 95% CI 1.20 −2.65; p= 0.0042) and calcium channel blocker use (HR=2.53, 95% CI 1.72–3.72; p<0.001) were associated; p= 0.0024 for interaction between ethnicity and the SNP. A common apoA1 SNP is associated with a significantly increased risk of recurrent cardiac events among Black, but not White, postmyocardial infarction patients. Relationships with lipoproteins may help explain this finding

Evaluation of valvular disease by cardiac computed tomography assessment.

Cardiac multidetector computed tomography (MDCT) angiography is emerging as a technique to evaluate cardiac valve structure and function. MDCT can provide insights into cardiac valve anatomy and pathologic states, including comparable efficacy in valve area and regurgitant orifice area assessment compared with echocardiography and magnetic resonance imaging. MDCT can also be useful when initial evaluation of valvular disease with echocardiography yields suboptimal images. MDCT provides concurrent visualization of coronary anatomy which may avoid the need for further invasive preoperative testing. Overall, more studies have shown the utility of MDCT in imaging of left-sided valves (aortic and mitral), whereas its ability in assessing right-sided valves (tricuspid and pulmonary) is somewhat limited. MDCT has shown promise as a valuable adjunctive imaging tool to conventional imaging modalities in providing essential anatomic and physiologic data on the sequelae of valvular dysfunction, with the potential of guiding both surgical and percutaneous management. MDCT technology continues to evolve, and more studies are indicated to further refine its precise role in the evaluation of patients with valvular pathology