High-Output Cardiac Failure in Patients with Multiple Myeloma

McBride, Wade; Jackman, John D.; Gammon, Roger S.; Willerson, James T.

doi:10.1056/nejm198812223192506

Cited by 44 publications

(25 citation statements)

References 15 publications

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“…Since VEGF is a multifunctional cytokine that stimulates vasodilation, vascular hyperpermeability, and angiogenesis, and was reported to stimulate endothelial nitric oxide production (7), we suspect that VEGFmay have decreased systemic vascular resistance in our patient resulting in the development of a high cardiac output state, which was followed by high-output heart failure. Onthe other hand, multiple myelomawas also reported to cause a high cardiac output state (8,9). Since both multiple myelomaand Crow-Fukase syndrome exhibit plasma cell dyscrasia, and since cytokines are suspected in the pathogenesis of both of these diseases (10, 1 1), we suspect that there may be a commonmechanism for the high cardiac output state in both multiple myelomaand Crow-Fukase syndrome, which might be mediated by VEGF.Further studies are necessary to clarify these points.…”

Section: Discussionmentioning

confidence: 97%

Crow-Fukase Syndrome Associated with High-Output Heart Failure.

et al. 2002

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A 64-year-old womanwas admitted with systemic edema and exertional dyspnea. High-output heart failure was diagnosed by right heart catheterization and she was treated with diuretics. After 3 weeks, her symptoms disappeared but a high cardiac output state persisted. A diagnosis of Crow-Fukasesyndromewas madebased on the presence of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes. Her serum vascular endothelial growth factor (VEGF) level was markedly elevated after recovery from heart failure. Wesuspect that an elevated VEGFlevel and a high cardiac output state mayplay a role in the pathogenesis of heart failure in Crow-Fukase syndrome. (Internal Medicine 41: 638-641, 2002)

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Section: Discussionmentioning

confidence: 97%

Crow-Fukase Syndrome Associated with High-Output Heart Failure.

et al. 2002

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“…Due to recent treatment advances, patients with multiple myeloma (MM) are living longer (Anderson, 2012;Kumar et al, 2014;Liwing et al, 2014), underscoring the importance of patient quality of life and management of adverse events (AEs) related to therapy. MM patients are at risk of cardiac events due to age and disease-related factors (McBride et al, 1988;Inanir et al, 1998;Robin et al, 2008;Kistler et al, 2012;Kwaan, 2013); there is also a risk of cardiac events due to cardiotoxicity from treatments including anthracyclines (Ky et al, 2013), proteasome inhibitors (Bockorny et al, 2012;Lonial et al, 2012;Herndon et al, 2013;Honton et al, 2013;Siegel et al, 2013) and high-dose therapy (Fatema et al, 2009;Chow et al, 2011;Sureddi et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of 3954 patients in phase 2/3 trials of bortezomib for the treatment of multiple myeloma: towards providing a benchmark for the cardiac safety profile of proteasome inhibition in multiple myeloma

et al. 2017

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Summary This retrospective analysis aimed to establish the overall cardiac safety profile of bortezomib using patient‐level data from one phase 2 and seven phase 3 studies in previously untreated and relapsed/refractory multiple myeloma (MM). Seven clinically relevant primary [congestive heart failure (CHF), arrhythmias, ischaemic heart disease (IHD), cardiac death] and secondary (hypertension, dyspnoea, oedema) cardiac endpoints were defined based on MedDRA v16.0 preferred terms. 2509 bortezomib‐treated patients and 1445 patients in non‐bortezomib‐based control arms were included. The incidence of grade ≥3 CHF was 1·3–4·0% in studies in relapsed/refractory MM and 1·2–4·7% in previously untreated MM (2·0–7·6% all grades), with no significant differences between bortezomib‐ and non‐bortezomib‐based arms in comparative studies. Incidences of arrhythmias (1·3–5·9% grade ≥2; 0·6–4·1% grade ≥3), IHD (1·2–2·9% all grades; 0·4–2·7% grade ≥3) and cardiac death (0–1·4%) were low, with no differences between bortezomib‐based and non‐bortezomib‐based arms. Higher rates of oedema (mostly grade 1/2) were seen in bortezomib‐based versus non‐bortezomib‐based arms in one study and a pooled transplant study analysis. Logistic regression analyses of comparative studies showed no impact on cardiac risk with bortezomib‐based versus non‐bortezomib‐based treatment. Bortezomib‐based treatment was associated with low incidences of cardiac events.

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“…Anemia was present at diagnosis but its correction did not improve cardiac failure. Moreover, McBride did not find a relationship between anemia and cardiac index [1]. …”

Section: Discussionmentioning

confidence: 99%

“…High cardiac output may be associated with MM. A relatively high prevalence (23%) has been reported in multiple myeloma [1–3]. Several mechanisms have been described but arteriovenous shunting in bone infiltrate disease has the most supportive data [1, 4].…”

Section: Introductionmentioning

confidence: 99%