Max Cancer Center, Saket, P-41, South Extension-2, New Delhi, India.
Cardiovasc Toxicol. 2012 Jun;12(2):184-7. doi: 10.1007/s12012-011-9146-7.
Bortezomib therapy is known to be associated with neurological side effects and thrombocytopenia. Its cardiac side effects are however not well known. The patient, a 70-year-old woman, with a previous history of myocardial infarction and subsequent coronary stenting, was detected to have multiple myeloma stage IIIa. She was started on Inj. Bortezomib (1.3 mg/m(2)) and Tab. Dexamethasone 40 mg on a weekly basis. She showed good response to therapy. Three days after administration of the 22nd dose of bortezomib, she presented to the hospital with congestive cardiac failure. Echocardiography revealed a drop in the left ventricular ejection fraction from pretreatment levels of 45-50 to 25%. Patient was treated medically for left ventricular failure secondary to a suspected ischemic etiology. Coronary angiography revealed non-critical coronary artery disease with patent right coronary artery and left circumflex stents. The N-terminal pro-brain natriuretic peptide (NT-proBNP) levels that were initially raised 4,030 pg/ml (<125 pg/ml) declined to 2,280 pg/ml a week later and subsequently normalized over the next 2 weeks. The patient responded well to treatment and was then discharged. The left ventricular ejection normalized over the next 3 months. Cardiac side effects of bortezomib are not well reported. Elderly patients and those with preexisting cardiac conditions could be at increased cardiovascular risk. Since this risk increases once a cumulative dose of 20 mg/m(2) has been administered, patients need to be monitored more intensively once this threshold has been attained. Increased awareness of these cardiac side effects is necessary for patients' safety.
硼替佐米治疗已知与神经副作用和血小板减少症有关。然而，其心脏副作用尚不清楚。患者为 70 岁女性，既往有心肌梗死和随后的冠状动脉支架置入史，诊断为 IIIa 期多发性骨髓瘤。她开始每周接受 Inj.硼替佐米（1.3mg/m(2)）和 Tab.地塞米松 40mg 的治疗。她对治疗反应良好。在接受第 22 次硼替佐米给药后 3 天，她因充血性心力衰竭而到医院就诊。超声心动图显示左心室射血分数从治疗前的 45-50%降至 25%。患者因疑似缺血性病因导致的左心室衰竭接受了药物治疗。冠状动脉造影显示非临界冠状动脉疾病，右冠状动脉和左回旋支支架通畅。最初升高的 N 端脑利钠肽前体（NT-proBNP）水平 4030pg/ml（<125pg/ml）在一周后降至 2280pg/ml，随后在接下来的 2 周内恢复正常。患者对治疗反应良好，随后出院。左心室射血分数在接下来的 3 个月内恢复正常。硼替佐米的心脏副作用报道不多。老年患者和有既往心脏疾病的患者可能存在心血管风险增加。由于一旦给予累积剂量 20mg/m(2)，这种风险就会增加，因此一旦达到这一阈值，患者需要更密切地监测。为了患者的安全，需要提高对这些心脏副作用的认识。
