From Hip to Heart: Cobalt-induced Cardiomyopathy Requiring Cardiac Transplantation

Singh, Manavotam; Ghazzal, Amre; Krishnan, Mrinalini; Kadakkal, Ajay; Hofmeyer, M.; Lam, Phillip H.; Rodrigo, M.E.; Kuwabara, Hiroto; Halushka, Marc K.; Molina, Ezequiel; Najjar, Samer S.; Sheikh, Farooq H.

doi:10.1016/j.cardfail.2020.09.463

Cited by 2 publications

(5 citation statements)

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“…However, the impact of standard heart failure therapies on prognosis is limited, and long‐term prognosis depends on the normalization of circulating cobalt levels and termination of exposure to cobalt, which is achievable by removing the cobalt source and, to a lesser extent, with chelation agents. 4 Of note, as seen in our case, improvement of cardiac function occurred only after removal of the cobalt source, even if the circulating cobalt levels declined modestly with chelation agents. If exposure persists, the course of cobalt‐induced cardiomyopathy is progressive, towards severe systolic dysfunction and death.…”

Section: Discussionsupporting

confidence: 71%

“…Management of cobalt‐induced cardiomyopathy includes heart failure treatment according to current guidelines. However, the impact of standard heart failure therapies on prognosis is limited, and long‐term prognosis depends on the normalization of circulating cobalt levels and termination of exposure to cobalt, which is achievable by removing the cobalt source and, to a lesser extent, with chelation agents 4 . Of note, as seen in our case, improvement of cardiac function occurred only after removal of the cobalt source, even if the circulating cobalt levels declined modestly with chelation agents.…”

Section: Discussionmentioning

confidence: 59%

“…If exposure persists, the course of cobalt‐induced cardiomyopathy is progressive, towards severe systolic dysfunction and death. Extreme presentations, such as cardiogenic shock or electric storm, requiring advanced mechanical circulatory support and heart transplantation can occur in patients who either were not previously diagnosed or failed to show reversal of cardiac abnormalities 2–4,12 …”

Section: Discussionmentioning

confidence: 99%

“…Extreme presentations, such as cardiogenic shock or electric storm, requiring advanced mechanical circulatory support and heart transplantation can occur in patients who either were not previously diagnosed or failed to show reversal of cardiac abnormalities. 2 , 3 , 4 , 12 …”

Section: Discussionmentioning

confidence: 99%

“… 1 Extreme presentations have been described, including electrical storm or cardiogenic shock requiring ventricular assist devices and heart transplantation. 2 , 3 , 4 Due to the fact that it can imitate other acquired or hereditary cardiomyopathies, correct diagnosis and specific management are often delayed. 5 …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Too young for an acquired cardiomyopathy? Cobalt metallosis as a cardiac amyloidosis mimicker

Casian,

Bica,

Ionescu

et al. 2024

ESC Heart Failure

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Metallosis with subsequent cardiac involvement is a possible long‐term complication of hip arthroplasty. We report the case of a young female referred to our centre for the suspicion of cardiac amyloidosis presenting with low electrocardiogram voltage, left ventricular hypertrophy, pericardial effusion, and global and longitudinal systolic impairment with apical sparing pattern. Her medical history was remarkable for arthroplasty in the context of congenital hip dysplasia. Two years prior to presentation, she underwent revision surgery for prosthesis malfunction, and tissue metallosis was initially documented. At the current presentation, cobalt metallosis was confirmed, as the circulating cobalt and chromium levels were severely elevated. The accurate diagnosis prompted the removal of the cobalt source with extensive tissue debridement and the use of chelating agents. Reversal of the cardiac abnormalities occurred as the circulating cobalt levels returned to normal.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%