Bell Elisabeth, Desuki Alexander, Karbach Susanne, Göbel Sebastian
Cardiology I-Center of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
University Cancer Center Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
Eur Heart J Case Rep. 2022 Sep 23;6(10):ytac396. doi: 10.1093/ehjcr/ytac396. eCollection 2022 Oct.
Cancer therapy-related cardiac dysfunction (CTRCD) is a challenging and life-threatening complication of many chemotherapeutic regimens. CTRCD prevention, diagnosis, and therapy require both careful interdisciplinary assessment and management. For patients with CTRCD, current guidelines of the European Society of Cardiology (ESC) recommend an angiotensin-converting-enzyme inhibitor in combination with a beta-blocker. Recent studies indicate a beneficial effect of sacubitril/valsartan in this patient population.
A 68-year-old female patient with a pleural epithelioid angiosarcoma developed heart failure with reduced ejection fraction and elevated serum biomarkers following doxorubicin treatment. After implementation of a recommended cardioprotective medical therapy including torasemide, ramipril, carvedilol, and spironolactone, the patient suffered two cardiac decompensations within 4 weeks after initiation of a paclitaxel regimen and pleural radiation therapy due to pain exacerbation. Despite a continuous application of the cardioprotective medical treatment regimen, no improvement of left-ventricular ejection fraction (LVEF) was detected in a 4-month follow up. Interestingly, after omitting ramipril and implementing low-dose sacubitril/valsartan (26/24 mg), we observed a decrease in serum biomarkers within 3 months as well as a significant improvement of LVEF within 6 months. After nearly 10 months of disease stabilization under paclitaxel, the patient suffered progressive cancer disease and deceased 1 week later after the initiation of a therapeutic attempt with pazopanib.
This case report highlights the importance of interdisciplinary care in cancer patients as well as the promising role of (low-dose) sacubitril/valsartan in patients with CTRCD even in the setting of delayed initiation.
癌症治疗相关的心脏功能障碍（CTRCD）是许多化疗方案中具有挑战性且危及生命的并发症。CTRCD的预防、诊断和治疗需要仔细的多学科评估和管理。对于CTRCD患者，欧洲心脏病学会（ESC）的现行指南推荐使用血管紧张素转换酶抑制剂联合β受体阻滞剂。最近的研究表明沙库巴曲缬沙坦对该患者群体有益。
一名68岁的女性胸膜上皮样血管肉瘤患者在接受阿霉素治疗后出现射血分数降低和血清生物标志物升高的心力衰竭。在实施包括托拉塞米、雷米普利、卡维地洛和螺内酯在内的推荐心脏保护药物治疗后，由于疼痛加剧，患者在开始紫杉醇方案和胸膜放射治疗后4周内发生了两次心脏失代偿。尽管持续应用心脏保护药物治疗方案，但在4个月的随访中未检测到左心室射血分数（LVEF）改善。有趣的是，在停用雷米普利并使用低剂量沙库巴曲缬沙坦（26/24mg）后，我们观察到3个月内血清生物标志物下降，6个月内LVEF显著改善。在紫杉醇治疗下病情稳定近10个月后，患者病情进展，在开始使用帕唑帕尼进行治疗尝试1周后死亡。
本病例报告强调了癌症患者多学科护理的重要性，以及（低剂量）沙库巴曲缬沙坦在CTRCD患者中即使延迟启动治疗时也具有潜在作用。
