ABSTRACT
A 42-year-old woman was referred to our Cardiac Intensive Care Unit for possible acute coronary syndrome (acute heart failure and elevated serum cardiac troponin levels). Urgent coronary angiogram was unremarkable. Transthoracic echocardiography revealed severe concentric biventricular hypertrophy, systolic dysfunction (LVEF 26%, FAC 20%), and restrictive physiology (E/E' 27). LV strain analysis showed an apical sparing pattern with severely reduced GLS (-6%) and raised the suspicion of cardiac amyloidosis (CA). The endomyocardial biopsy established the diagnosis of lightchains CA. The patient's prognosis was very poor at the diagnosis, with a median survival of 4 months based on Mayo Clinic's revised staging system. Combination chemotherapy with CyBorD scheme (Cyclofosfamide/Bortezomib/Dexamethasone) was promptly started, but prematurely stopped because of the development of rapidly progressive biventricular failure. Therefore, the patient received a total artificial heart (TAH) as a bridge-to-candidacy to orthotopic heart transplantation (OHT). The CyBorD therapy was then restarted, and complete haematological remission was achieved six months later. Therefore, the patient underwent effective monoclonal antibody therapy for nosocomial SARS-CoV-2 infection. Subsequently, the patient was placed on the urgent transplant list because of the bacterial device's driveline infection. Two months later, she underwent OHT. The patients died three days for multiple reasons: difficult TAH explant with prolonge extracorporeal circulation time, the necessity of central V-A ECMO, graft failure.
ABSTRACT
PURPOSE: A nationwide lockdown was enforced in Brazil starting in March 2020 because of the COVID-19 pandemic when cancer screening activities were reduced. In this study, we evaluated the impact of the COVID-19 pandemic on breast cancer (BC) diagnosis. METHODS: We extracted data from the medical records of patients age older than 18 years who were diagnosed with BC and started treatment or follow-up in private oncology institutions in Brazil between 2018 and 2021. The primary objective was to compare the stage distribution during the COVID-19 pandemic (2020-2021) with a historical prepandemic control cohort (2018-2019). Early BC was defined as stage I-II and advanced disease as stage IV. RESULTS: We collected data for 11,753 patients with an initial diagnosis of BC, with 6,493 patients in the pandemic (2020-2021) and 5,260 patients in the prepandemic period (2018-2019). We observed a lower prevalence of early-stage BC (63.6% v 68.4%) and a higher prevalence of advanced-stage BC (16.9 v 12.7%), after the onset of the pandemic (both P < .01). This pattern was similar for both estrogen receptor-positive/human epidermal growth factor receptor 2-negative and human epidermal growth factor receptor 2-positive tumors: significantly decreased in the early stage from 69% to 67% and 68% to 58%, respectively, and a considerable increase in advanced-stage disease from 13% to 15% and 13% to 20%, respectively. For triple-negative BC, there was a significantly higher percentage of patients with advanced-stage disease during the pandemic (17% v 11%). Overall, age 50 years or older and postmenopausal status were associated with a greater risk of advanced stage at diagnosis during the pandemic period. CONCLUSION: We observed a substantial increase in the number of cases of advanced-stage BC in Brazil during the COVID-19 pandemic.