Characteristics of neoplastic cardiac tamponade and prognosis after pericardiocentesis: a single-center study of 113 consecutive cancer patients.

BACKGROUND: Neoplastic cardiac tamponade (NCT) is a life-threatening complication of cancer. The interval between cancer diagnosis and NCT onset and the prognosis after pericardiocentesis may differ according to cancer type. METHODS AND RESULTS: We performed a retrospective study of 113 patients (54 % male) with NCT who underwent pericardiocentesis at Niigata Cancer Center Hospital between 1992 and 2013. Mean age at NCT was 61.2 years (range 15.9-94.8 years). The most common underlying cancers were lung cancer (59.2 %), breast cancer (21.2 %), lymphoma/leukemia (5.3 %), and gastric/esophageal cancer (5.3 %). The median time from cancer diagnosis to NCT onset was 9.0, 60.4, 5.6, and 8.0 months for lung cancer, breast cancer, lymphoma/leukemia, and gastric/esophageal cancer, respectively. Kaplan-Meier survival estimates were worse for breast cancer patients with NCT than for matched breast cancer patients without NCT (P < 0.0001). Median survival time after pericardiocentesis was 2.9, 4.2, 2.3, and 0.6 months for lung cancer, breast cancer, lymphoma/leukemia, and gastric/esophageal cancer, respectively; one-year survival after pericardiocentesis was 6.0, 16.7, 33.3, and 0 %, respectively. CONCLUSIONS: The interval between cancer diagnosis and NCT onset, the impact of NCT on prognosis, and the prognosis after pericardiocentesis differed according to cancer type. Healthcare practitioners caring for patients with NCT should recognize the differences between cancer types and customize their care accordingly.

[Protocol for administration of trastuzumab based on cardiac function].

We analyzed 7 patients with breast cancer who suffered from trastuzumab-associated cardiac dysfunction. Left ventricular ejection fraction (EF) was calculated by M-mode echocardiography. We propose a protocol for the administration of trastuzumab based on EF in the clinical courses of the 7 patients and the literatures concernig trastuzumab. If the EF is ≥60%, an echocardiography is performed every 3 months during trastuzumab therapy. If the EF is ≥53% and ≤60%, an echocardiography is performed every 2 months. If the EF is ≤53%, an echocardiography is performed more frequently. If the EF decreases by ≥10% from its previous level, an echocardiography is performed after 3 weeks. Also, trastuzumab is withheld when the EF falls to ≤45%. When the EF falls to ≤40%, the standard treatment for congestive heart failure is initiated. An echocardiography is performed every 2 weeks after trastuzumab is withheld. Trastuzumab therapy can be resumed if the EF improves to ≥50%.

[Two cases of unstable angina in patients treated with bevacizumab].

Adverse events associated with bevacizumab (BV) were haemorrhage, impaired wound healing and arterial thromboembolism. We report 2 patients with colorectal cancer who underwent percutaneous coronary intervention (PCI) for unstable angina soon after administration of chemotherapy including BV. CASE 1: A 74-year-old male with rectal cancer and simultaneous liver metastases was admitted to our hospital for unstable angina. Before admission he had received 4 courses of chemotherapy including BV. He had no coronary risk factors besides old age. Since coronary angiography (CAG) revealed significant stenosis in the mid-left circumflex coronary artery, PCI with a coronary stent was performed without any complications. CASE 2: A 67-year-old male with colon cancer and liver and lung metastases was referred to our Dept. of Internal Medicine for unstable angina. Before referral, he had undergone 28 courses of chemotherapy including BV. He had a history of familial hyperlipidemia and smoking. Since CAG revealed significant stenoses in the proximal left anterior descending coronary artery, PCI with coronary stents was performed without any complications. These 2 patients had no angina after PCI. PCI with coronary stent was safely performed in this patient with unstable angina soon after administration of chemotherapy including BV.

[Trastuzumab-associated cardiac dysfunction].

We analyzed 127 consecutive patients who received trastuzumab-based chemotherapy from December, 2003 to February, 2009 in our hospital. Of 127 patients, cardiac dysfunction appeared in 6 patients(4. 7%). Cardiac dysfunction was defined as a decline in left ventricular (LV) ejection fraction (EF) < or =55% with absolute reduction of at least 10% from baseline. Among the 6 patients with cardiac dysfunction, one patient suffered symptomatic heart failure. Other patients were asymptomatic. The 4 patients of the 5 patients recovered their cardiac dysfunction after withdrawal of trastuzumab. Patients with trastuzumab-associated cardiac dysfunction had a history of administration of epirubicin or taxane, lower registration LVEF, and larger LV end-diastolic dimension (> or =49 mm). We recommend that LV function be assessed by echocardiography or multigated radionuclide angiography scans prior to instituting trastuzumab therapy and at three-month intervals during therapy. Trastuzumab should be discontinued in patients who develop a decrease in LVEF below 45% or congestive heart failure.

The usefulness of chemotherapy for control of ventricular arrhythmias secondary to cardiac metastasis of germ cell tumor.

A 14-year-old boy was referred to our hospital because of treatment of germ cell tumor in the anterior mediastinum. Computerized tomographic (CT) scan of the chest and abdomen revealed a large tumor in the anterior mediastinum and multiple metastatic tumors in the lung, liver, kidney, pancreas, and heart. There was a mass in the interventricular septum. A 24-h Holter monitor showed sinus rhythm with 358 premature ventricular complexes (VPC) and 30 ventricular runs including 9 non-sustained ventricular tachycardias per day. The patient was treated with 4 cycles of chemotherapy with good response. Approximately 12 weeks after the start of the chemotherapy, serial CT scan showed regression of the tumors in the anterior mediastinum, lung, and kidney, and disappearance of the tumors in the liver, pancreas, and heart. Repeat Holter monitor showed that VPC and ventricular runs disappeared completely. The chemotherapy for the germ cell tumor was very useful for ventricular arrhythmias secondary to cardiac metastasis of the tumor.

Systolic dysfunction in urban Japan.

BACKGROUND: Heart failure (HF), which can be caused by left ventricular systolic dysfunction (LVSD), is a growing problem in developed countries with a large aging population. The aim of the present study was to characterize outpatients with LVSD in the adult population (45-84 years) in an urban Japanese community (Niigata City), and delineate their characteristics in comparison with those in a rural one (Sado). METHODS AND RESULTS: Over a 5-year period, 1,297 patients (67% males) with LVSD (defined as ejection fraction < or =50%) were extracted from 87,953 echocardiography records available in 15 hospitals in Niigata City. The proportion of LVSD increased progressively with age (p-for-trend <0.0001), reaching 1-2% in those aged > or =75 years. The prevalence of comorbidities was noticeable (47% had hypertension, 41% myocardial ischemia, 34% atrial fibrillation, 33% previous hospitalization because of congestive HF, 27% cerebral stroke). In comparison with Sado, Niigata patients were younger, with a higher prevalence of comorbidities (hypertension, diabetes, dyslipidemia, and cerebral stroke). CONCLUSIONS: As the proportion of LVSD cases increases progressively with age, it is expected to simulate a future epidemic. The differences between patients' characteristics and disease patterns in urban and rural communities may favor individually tailoring preventive strategies for HF in these areas.

[Efficacy of cardiac monitoring with echocardiography in adult patients receiving adriamycin].

The usefulness of adriamycin is limited by its cardiotoxicity. The purpose of the present study was to examine the usefulness of sequential monitoring of cardiac function of patients undergoing adriamycin therapy. In this cardiologic monitoring procedure a baseline echocardiogram should be obtained when the cumulative adriamycin dose was between 450 mg/m2 and 550 mg/m2. Subsequent echocardiograms should be obtained for every increase of 100 mg/m2 after the baseline study. Adriamycin was withheld when the left ventricular ejection fraction fell below 58%. This protocol was performed in 128 adult patients who received adriamycin at Niigata Cancer Center Hospital between 1995 and 2001. Forty-seven adult patients were able to tolerate more than 550 mg/m2 of adriamycin under this protocol. None of the 128 adult patients developed congestive heart failure when this protocol was used. This cardiologic monitoring procedure can be useful in adult patients receiving adriamycin.