Apical takotsubo syndrome in a patient with metastatic breast carcinoma on novel immunotherapy

Anderson, R. D.; Brooks, Matthew

doi:10.1016/j.ijcard.2016.07.291

Cited by 33 publications

(20 citation statements)

References 2 publications

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“…Non-inflammatory cardiovascular toxicities have been reported in individual cases. These include Takotsubo-like syndrome with both apical 6,25,26 and basal variants 27 ; asymptomatic non-inflammatory left-ventricular dysfunction 28 ; myocardial infarction 29 ; and coronary vasospasm. 30 Arrhythmias have also emerged as a sign of cardiotoxicity in patients receiving ICI.…”

Section: Overview Of Immune-related Adverse Events From Icismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

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Cardiovascular toxicities associated with immune checkpoint inhibitors (ICIs) have been reported in case series but have been underappreciated due to their recent emergence, difficulties in diagnosis and non-specific clinical manifestations. ICIs are antibodies that block negative regulators of the T cell immune response, including cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and PD-1 ligand (PD-L1). While ICIs have introduced a significant mortality benefit in several cancer types, the augmented immune response has led to a range of immune-related toxicities, including cardiovascular toxicity. ICI-associated myocarditis often presents with arrhythmias, may co-exist with myositis and myasthenia gravis, can be severe, and portends a poor prognosis. In addition, pericardial disease, vasculitis, including temporal arteritis, and non-inflammatory heart failure, have been recently described as immune-related toxicities from ICI. This narrative review describes the epidemiology, diagnosis, pathophysiology, and treatment of cardiovascular toxicities of ICI therapy, highlighting recent developments in the field in the past year. Keywords Cardio-oncology • Immune checkpoint inhibitors • Myocarditis • Vasculitis • Pericarditis • Cardiovascular toxicity This article is part of the Spotlight Issue on Cardio-oncology.

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Section: Overview Of Immune-related Adverse Events From Icismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

View full text Add to dashboard Cite

show abstract

“…The former includes myocarditis, perimyocarditis, pericarditis, left ventricular dysfunction without myocarditis, and others (Lyon et al, 2018). The latter includes asymptomatic noninflammatory left ventricular dysfunction (Roth et al, 2016), Takotsubo-like syndrome with both basal (Ederhy et al, 2018) and apical (Geisler et al, 2015; Anderson and Brooks, 2016) variants, coronary vasospasm (Nykl et al, 2017), arrhythmias (Salem et al, 2018), and myocardial infarction (Weinstock et al, 2017). Of all the cardiotoxicity-associated ICIs, myocarditis is the most common cardiotoxic reaction.…”

Section: Incidence and Clinical Manifestations Of Immune Checkpoint Imentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Cardiotoxicity: Current Understanding on Its Mechanism, Diagnosis and Management

et al. 2019

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Immune checkpoint inhibitors (ICIs) that target cytotoxic T lymphocyte antigen 4, programmed cell death-1, and PD-ligand 1 have revolutionized cancer treatment, achieving unprecedented efficacy in multiple malignancies. ICIs are increasingly being used in early cancer settings and in combination with various other types of therapies, including targeted therapy, radiotherapy, and chemotherapy. However, despite the excellent therapeutic effect of ICIs, these medications typically result in a broad spectrum of toxicity reactions, termed immune-related adverse events (irAEs). Of all irAEs, cardiotoxicity, uncommon but with high mortality, has not been well recognized. Herein, based on previous published reports and current evidence, we summarize the incidence, diagnosis, clinical manifestations, underlying mechanisms, treatments, and outcomes of ICI-associated cardiotoxicity and discuss possible management strategies. A better understanding of these characteristics is critical to managing patients with ICI-associated cardiotoxicity.

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“…Analysis of the multicenter GEIST (German Italian Stress Cardiomyopathy) Registry data failed to identify any independent predictors of TTS recurrence [28]. Presence of malignancy has been shown to be associated with higher risk of TTS in numerous studies [29][30][31], and there are numerous reports of TTS associated with chemotherapy or immunotherapy [32][33][34][35][36]. It is plausible that interruption in chemotherapy after initial episode of TTS may play a role in explaining the lack of difference in TTS recurrence rate in those with malignancy.…”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

Jang

Yeo

Jonas

et al. 2020

Preprint

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Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.

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Apical takotsubo syndrome in a patient with metastatic breast carcinoma on novel immunotherapy

Cited by 33 publications

References 2 publications

Cardiovascular toxicities associated with immune checkpoint inhibitors

Cardiovascular toxicities associated with immune checkpoint inhibitors

Immune Checkpoint Inhibitor-Associated Cardiotoxicity: Current Understanding on Its Mechanism, Diagnosis and Management

Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

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