Efficacy of mitral annular velocity as an alternative marker of left ventricular global longitudinal strain to detect the risk of cancer therapy-related cardiac disorders.

PURPOSE: Left ventricular longitudinal function can be rapidly evaluated by measuring S' and mitral annular plane systolic excursion (MAPSE) using tissue Doppler imaging. Even when the image quality is poor and the left ventricular endocardium is not visible, S' and MAPSE can be measured if the mitral annulus is visible. However, the utility of S' and MAPSE in diagnosing cancer therapy-related cardiac dysfunction (CTRCD) remains unclear. This study aimed to examine the diagnostic performance of S' and MAPSE and determine appropriate cutoff values. METHODS: We retrospectively enrolled 279 breast cancer patients who underwent pre- or postoperative chemotherapy with anthracyclines and trastuzumab from April 2020 to November 2022. We compared echocardiographic data before chemotherapy, 6 months after chemotherapy initiation, and 1 year later. CTRCD was defined as a decrease in left ventricular ejection fraction below 50%, with a decrease of ≥10% from baseline or a relative decrease in left ventricular global longitudinal strain (LVGLS) of ≥15%. RESULTS: A total of 256 participants were included in this study, with a mean age of 50.2 ± 11 years. Fifty-six individuals (22%) developed CTRCD within 1 year after starting chemotherapy. The cutoff value for septal S' was 6.85 cm/s (AUC = .81, p < .001; sensitivity 74%; specificity 73%), and for MAPSE was 11.7 mm (AUC = .65, p = .02; sensitivity 79%; specificity 45%). None of the cases with septal S' exceeding 6.85 cm/s had an LVGLS of ≤15%. CONCLUSIONS: Septal S' is a useful indicator for diagnosing CTRCD. HIGHLIGHTS: Septal S' decreased at the same time or earlier than the decrease in LVGLS. The septal S' demonstrated higher diagnostic ability for CTRCD compared to LVGLS.

Ovarian cancer mortality among women aged 40-79 years in relation to reproductive factors and body mass index: latest evidence from the Japan Collaborative Cohort study.

OBJECTIVE: This study mainly aimed to investigate the association of ovarian cancer mortality with reproductive factors and body mass index among Japanese women aged 40-79 years. METHODS: The source of the data was the Japan Collaborative Cohort (JACC) study which covered the period of 1988 to 2009. A representative sample of 64,185 women was used. Cox model was used to estimate the relative risk (RR) and 95% confidence interval (CI). RESULTS: The total number of ovarian cancer deaths was 98, with a mortality rate of 9.30 per 100,000 person-years. Women with single marital status revealed significantly higher age-adjusted RR (RR, 4.11; 95% CI, 1.66 to 10.23; p=0.005) as compared to married women. The effect of single marital status was stronger among older women aged 50+ years (RR, 4.58; 95% CI, 1.65 to 12.72; p=0.003) than younger women. An elevated risk was found for both nulliparous and nullipregnant women. Similarly, an increased risk of ovarian cancer mortality was estimated among overweight among aged 50 years or less. CONCLUSION: Out of many factors only single marital status indicated a higher risk for ovarian cancer mortality. All other factors provided inconclusive results, which imply further epidemiological investigations.

[Long-term survival after autologous peripheral blood stem cell transplantation in a patient with primary AL amyloidosis complicating congestive heart failure].

A 44-year-old man was admitted to hospital because of respiratory distress and progressive edema in the lower extremities. He was diagnosed as having congestive heart failure, but his condition improved following intensive care. Echocardiogram revealed a thickened interventricular septum, insufficient diastolic function, and granular sparkling pattern in the ventricular wall. Pathological examination of a myocardial biopsy specimen showed the deposition of AL amyloid, resulting in a diagnosis of AL amyloidosis. He was then referred to our hospital for treatment. After a course of high-dose dexamethasone therapy, peripheral blood stem cells induced by the administration of granulocyte colony stimulating factor were harvested. He then received high-dose melphalan (HDM) with autologous peripheral blood stem cell transplantation (auto-PBSCT) support, leading to complete remission. He has been well for more than three years after the transplantation and enjoys the same daily life as before the onset of symptoms. HDM/auto-PBSCT for AL amyloidosis confers a higher response rate and longer survival than conventional chemotherapies; however, treatment-related toxicity is also high. Refinements of treatment strategies are urgently needed. This case provides insights into appropriate strategies for HDM/auto-PBSCT for AL amyloidosis with regard to patient selection, the best induction therapy, and the risk-adjusted melphalan conditioning dose; all of which should be confirmed by randomized controlled trials.

[Effective combination therapy of bortezomib and dexamethasone for two patients with refractory multiple myeloma].

We describe 2 cases of conventional therapy-resistant multiple myeloma (MM) that responded to bortezomib and dexamethasone therapy. Case 1: A 62-year-old woman with MM (IgG, kappa-type, stage IIIA) resistant to DMVM-IFN (dexamethasone, ranimustine, vincristine, melphalan, interferon-a), VAD (vincristine, doxorubicin, dexamethasone), high-dose melphalan with autologous peripheral blood stem cell transplantation (PBSCT) and thalidomide, received 2 courses of bortezomib treatment. In the first course, bortezomib alone was administered and then in the second course bortezomib was given in combination with dexamethasone. The patient's serum IgG level decreased from 8040 to 1020 mg/dl and the level of plasma cells in bone marrow was 1.2% after the treatments. Adverse reactions including rash, anemia, and thrombocytopenia occurred in the first course; however, they were milder in the second course combined with dexamethasone. Case 2: A 43-year-old man with MM (IgD, gamma-type, stage IIA) resistant to conventional and high-dose chemotherapy with PBSCT as well as thalidomide therapy, received treatment with bortezomib alone and then in combination with dexamethasone. His serum IgD level decreased from 2140 to 623 mg/dl. He suffered adverse reactions such as fatigue, anemia, and thrombocytopenia in the first course, which were relieved in the second course. These results indicate that the combination of bortezomib and dexamethasone is effective in the treatment of refractory MM and that dexamethasone can reduce the adverse reactions of bortezomib.

A case of systemic lupus erythematosus with postpartum hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and concomitant high phosphatidylserine-dependent anti-prothrombin antibody levels.

In August 1994, a 19-year-old woman presented to her dermatologist with a slight fever, arthralgia, and a butterfly rash. Discoid lupus erythematosus was suspected, and serological testing yielded positive results for antinuclear antibody. She was diagnosed with systemic lupus erythematosus without organ failure and was treated with only nonsteroidal antiinflammatory drugs. She became pregnant in June 2001, at age 26. In November her obstetrician noted that she had severe hypertension, edema of the low limbs, and proteinuria. On admission, she was diagnosed with severe preeclampsia, and cesarean section was performed. On hospital day 3 the patient developed sudden epigastric pain and vomiting. Laboratory tests revealed thrombocytopenia, liver dysfunction, and microangiopathic hemolytic anemia, leading to a diagnosis of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Plasma exchange was performed for 5 days. The thrombocytopenia, liver dysfunction, and proteinuria diminished quickly. Later testing revealed a high titer of plasma phosphatidylserine-dependent anti-prothrombin antibody. This case is useful for exploring the relations between SLE, HELLP syndrome, and anti-prothrombin antibody.