Cardiac Rehabilitation Improves Fitness in Patients With Subclinical Markers of Cardiotoxicity While Receiving Chemotherapy: A RANDOMIZED CONTROLLED STUDY.

PURPOSE: Heart failure (HF) due to cardiotoxicity is a leading non-cancer-related cause of morbidity and mortality in cancer survivors. Cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and reduces morbidity and mortality in patients with HF, but little is known about its effects on cardiotoxicity in the cancer population. The objective of this study was to determine whether participation in CR improves CRF in patients undergoing treatment with either doxorubicin or trastuzumab who exhibit markers of subclinical cardiotoxicity. METHODS: Female patients with cancer (n = 28: breast, n = 1: leiomyosarcoma) and evidence of subclinical cardiotoxicity (ie, >10% relative decrease in global longitudinal strain or a cardiac troponin of >40 ng·L -1 ) were randomized to 10 wk of CR or usual care. Exercise consisted of 3 d/wk of interval training at 60-90% of heart rate reserve. RESULTS: Cardiorespiratory fitness, as measured by peak oxygen uptake (V˙ o2peak ), improved in the CR group (16.9 + 5.0 to 18.5 + 6.0 mL∙kg -1 ∙min -1 ) while it decreased in the usual care group (17.9 + 3.9 to 16.9 + 4.0 mL∙kg -1 ∙min -1 ) ( P = .009). No changes were observed between groups with respect to high-sensitivity troponin or global longitudinal strain. CONCLUSION: This study suggests that the use of CR may be a viable option to attenuate the reduction in CRF that occurs in patients undergoing cardiotoxic chemotherapy. The long-term effects of exercise on chemotherapy-induced HF warrant further investigation.

Diffuse B Cell Lymphoma Leading to Complete Heart Block: Is This Transient or Permanent?

BACKGROUND Cardiac lymphomas can lead to heart block through tumor disruption of the cardiac conduction system. It is reported that with cardiac tumor treatment, conduction abnormalities can resolve. We present a case of cardiac lymphoma resulting in complete heart block requiring a pacemaker, followed by reduction of the pacing burden after chemotherapy. CASE REPORT A 72-year-old woman with a medical history of hypertension, hypothyroidism, and persistent atrial fibrillation presented with dyspnea on exertion and fatigue for 2 weeks. Electrocardiography revealed complete heart block with junctional bradycardia of 48 beats per min. Transthoracic echocardiography demonstrated preserved left ventricular systolic function along with a large mass (3.6×3.7 cm). An endomyocardial biopsy was consistent with diffuse large B cell lymphoma, and the cardiac involvement was thought to be secondary based on positron emission tomography scan findings. Her clinical course was complicated by an episode of syncope deemed to be due to transient asystole, and an urgent single-chamber permanent pacemaker was implanted. Chemotherapy was initiated with R-CHOP, and, following the second cycle of chemotherapy, a positron emission tomography scan revealed no increased radiotracer uptake and thus resolution of all tumors. An echocardiogram 6 weeks after chemotherapy showed complete resolution of the cardiac mass. Subsequent serial pacemaker checks demonstrated improvement of atrioventricular nodal function as manifested by reduced pacing burden. CONCLUSIONS Lymphoma with cardiac involvement can lead to conduction abnormalities, including CHB, and heart block in the setting of these tumors may be reversible with appropriate therapy; however, implantation of a pacemaker remains inevitable is some cases.

An unusual case of cholecystitis.

A 56-year-old woman with diabetes who had undergone a coronary artery bypass surgery for triple-vessel coronary artery disease presented 2 weeks after discharge with classic features of cholesterol embolization, blue toes, renal insufficiency, and intractable abdominal pain. Despite a multitude of investigations, the cause of her abdominal pain was elusive. Laparoscopic cholecystectomy revealed the cause: acute cholecystitis secondary to cholesterol crystal embolization. Although rare, cholecystitis as a manifestation of cholesterol embolization can occur, and prompt recognition will prevent unnecessary investigations and ensure immediate treatment.