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JACC March 20, 2018

Volume 71, Issue 11

FIT Clinical Decision Making

ACUTE ANTHRACYCLINE INDUCED CARDIOTOXICITY: A RARE AND REVERSIBLE CAUSE OF ACUTE
SYSTOLIC HEART FAILURE
Poster Contributions
Poster Hall, Hall A/B
Sunday, March 11, 2018, 9:45 a.m.-10:30 a.m.

Session Title: FIT Clinical Decision Making: Heart Failure and Cardiomyopathies
Abstract Category: Heart Failure and Cardiomyopathies
Presentation Number: 1191-128

Authors: Hoyle Whiteside, Arun Nagabandi, Amudhan Jyothidasan, Kristen Brown, John Thornton, Medical College of Georgia at Augusta
University, Augusta, GA, USA
Background: Chronic anthracycline induced cardiotoxicity (AIC) is a type 1 chemotherapeutic cardiotoxicity characterized by irreversible
myocyte destruction and necrosis. Although rare, acute AIC is characterized by a transient decline in left ventricular ejection fraction (LVEF)
and does not appear to be dose related. The mechanism of acute AIC is not well defined, but the condition is felt to be reversible.
Case: A 58 year old female with history of polycythemia vera and no cardiac history underwent induction chemotherapy with 7+3 cytarabine
and daunorubicin (90 mg/m2) for acute myeloid leukemia. Baseline echocardiogram demonstrated normal LVEF. On day 15 of induction,
she developed tachypnea, dyspnea at rest, tachycardia, and mild troponin I elevation (0.106) which prompted cardiology consultation.
Decision-making: Physical exam findings were consistent with decompensated heart failure, BNP was elevated (2190 pg/mL), and
transthoracic echocardiogram revealed an interval decline in LVEF to 42% (Teicholz). On day 17 of induction, she developed polymorphic
ventricular tachycardia in the setting of prolonged QTc and multiple electrolyte abnormalities with resultant hypoxemia prompting ICU
transfer. Heart failure symptoms responded to afterload reduction, IV diuresis, and subsequent initiation of a beta blocker and the patient
was transferred back to the floor on guideline directed medical therapy. LVEF remained reduced (35-40%) at the time of hospital discharge
and overall prognosis was grim due to severity of underlying malignancy.
Conclusion: Acute AIC is a rare cause of left ventricular failure which should be considered in patients developing acute respiratory
failure as early as one week following anthracycline exposure. Prompt cardiology referral and appropriate pharmacologic intervention is
paramount as left ventricular dysfunction is considered to be reversible.