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2. C31 NEXT GENERATION MYOCARDITIS

Author

Mistrulli, R, Cartoni, D, Andreoli, F, Lestuzzi, C, Paccone, A, Gallucci, G, Fiscella, D, Petrolati, S, and Bisceglia, I

Abstract

A 75–year–old overweight man, affected by hypertension, diabetes mellitus and atrial fibrillation since 2020. After 3 unsuccessful attempts of electrical cardioversion it was opted for a strategy of rate control with beta blocker and anticoagulant therapy with Rivaroxaban 20 mg. Following episodes of rectal bleeding; adenocarcinoma of the colon was diagnosed. The patient underwent hemicolectomy and started therapy with Pembrolizumab. The anticoagulant was replaced with Edoxaban 60 mg. In August 2022, he was admitted to the emergency department for severe signs and symptoms of heart failure. On ECG, atrial fibrillation with a heart rate of 90 bpm and non–specific changes in ventricular repolarization. The echocardiogram showed a severe reduction of the ejection fraction (FE 30%), which was not present at previous controls. On blood tests, troponins were negative and BNP increased. The patient underwent coronarography which was negative for significant lesions, and heart failure therapy was prescribed. Three months later the patient came to our cardio–oncology outpatient clinic; we repeated the echocardiogram which showed a recovery of the ejection fraction to 45% and planned a cardiac MRI. Cardiac MRI (CMR) showed global left ventricular hypokinesia (FE 42%) and late subepicardial gadoline enhancement in the basal segment of the inferior wall and transmural in the basal segment of the lateral wall without signs of oedema. Report described as compatible with myocarditis. The case was discussed collegially with radiologists and oncologists, and it was decided to discontinue immunotherapy (ICI). Myocarditis is the most common cardiovascular adverse events of ICI therapy, although it has a very low incidence. Generally, myocarditis related to ICI therapy has a high mortality rate and requires discontinuation of ICI. In addition, CMR may have a lower sensitivity in this setting. There is also a possibility of developing left ventricular dysfunction without associated myocarditis in the absence of increase in cardiac troponin and active myocardial inflammation at CMR. Although our case has been defined as myocarditis, it presents some unclear aspects due in part to the early non–diagnosis as a complication of ICI therapy. Although cancer patients taking ICI has expanded considerably in recent years, the evidence on cardiovascular complications is scarce and unknown to the clinical cardiologist.

Published
2023
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3. P424 MEDIASTINAL ROUND CELL SARCOMA WITH PULMONARY ARTERY STENOSIS: CLINICAL USEFULNESS OF CARDIAC MRI IN CARDIO–ONCOLOGY

Author

Canale, M, Bisceglia, I, Gallucci, G, Turazza, F, Camilli, M, Russo, G, Lestuzzi, C, Paccone, A, Fiscella, D, Maurea, N, Bucciarelli Ducci, C, Baldi, G, Casolo, G, and Camerini, A

Abstract

Case description: a previously healthy 26–year–old man presented with dyspnea on exertion and dry cough. CT scan revealed a large mediastinal mass with displacement of great vessels and trachea and pericardial effusion. Cardiac MRI showed the huge mediastinal mass, literally leaning on the heart with signs of compression of the pulmonary artery (Figure 1) with the typical D–shape of inter ventricular septum. Pericardial effusion did not compress the RV due to high intraventricular pressure. At baseline echo the mass simulated pulmonary artery stenosis as a consequence of pulmonary artery “ab extrinseco” compression. Surgical biopsy showed Ewing sarcoma lately redefined into undifferentiated round cell sarcoma so the patient started chemotherapy with VAI (vincristine, adriblastine, and ifosfamide) x6 followed by maintenance etoposide and ifosfamide (no anthraciclines for risk of cardiac toxicity). After induction phase MRI showed a partial response to treatment; mediastinal mass further reduced at the end of maintenance (Figure 2). Pericardial effusion disappeared and peak velocity of pulmonary artery went back to normal level at echo. Our patient underwent surgery with en–block removal of mediastinal mass with pericardium and anonymous vein and partial pulmonary upper left lobe resection with R0 resection. Pathology report confirmed an undifferentiated round cell sarcoma (possible embryonal origin, FISH analysis for EWS/FUS genes and 12p negative). Adjuvant mediastinal radiotherapy was delivered. The patient is alive without disease recurrence at one–year follow–up.

Published
2023
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4. P420 A CANCER PATIENT WITH PULMONARY THROMBOEMBOLISM: IS IT RIGHT TO APPLY THE CRITERIA FOR DOSE REDUCTION IN THESE PATIENTS?

Author

Russo, G, Guglielmi, A, Cherubini, A, Faganello, G, Bisceglia, I, Canale, M, Camilli, M, Fiscella, D, Paccone, A, Gallucci, G, Turazza, F, Lestuzzi, C, Cappelletto, C, Mazzone, C, Bollini, M, Grande, E, Ius, A, Mattei, L, and Di Lenarda, A

Abstract

A 78 years old woman presented in our cardio–oncology out–patient clinic to renew apixaban treatment plan. In her medical history she was a former smoker, with a chronic kidney disease in IIIb stadium according to KDIGOI guidelines with a creatinine of 1,54 mg/dl, GFR according CKD 32 ml/min/1.73m2 and according Cockcroft e Gault 28 ml/min/1.73m2. In 2010, she had a right lobe pulmonary cancer diagnosis treated in neo–adjuvant with gemcitabine. After chemotherapy, she underwent surgical lobectomy. During hospitalization she had a deep venous thrombosis complicated by pulmonary thromboembolism, heparin sc was given with resolution of the clinical picture. In 2012 she had a recurrence of pulmonary thromboembolism. Heparin and warfarin in a second time was given. In 2016 for cancer disease progression, she underwent various oncological treatments and she found a stability disease with osimertinib and stereotaxic radiotherapy. Warfarin was switched to apixaban low–doses for low weight and chronic kidney disease. In 2021 in osimertinib therapy, cancer was under control. She was continuing low–dose apixaban. One year later, a CT scan demonstrated a disease progression and inferior cava venous thrombosis. A cardiac evaluation in our unit was required: patients was asymptomatic. EKG and Echocardiogram were normal. Apixaban low dose was changed to edoxaban 30 mg. There was a complete vein recanalization. Unfortunately, patient died after 8 months for cancer. It is important, in the direct oral anticoagulation therapy in cancer patient, to consider not only the indication for dose reduction known by the registration studies but also cancer and therapy factors.

Published
2023
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6. Trastuzumab adjuvant chemotherapy and cardiotoxicity in real-world women with breast cancer.

Author

Tarantini L, Cioffi G, Gori S, Tuccia F, Boccardi L, Bovelli D, Lestuzzi C, Maurea N, Oliva S, Russo G, Faggiano P, and Italian Cardio-Oncologic Network

Abstract

BACKGROUND: Adjuvant trastuzumab therapy improves survival of human epidermal growth factor receptor 2 (HER2)-positive women with early breast cancer (EBC). A careful monitoring of cardiac function is needed due to potential trastuzumab cardiotoxicity (Tcardiotox). To date, the incidence, timing, and phenotype of patients with Tcardiotox in clinical practice are not well known. METHODS AND RESULTS: A total of 499 consecutive HER2-positive women (mean age 55 ± 11 years) with EBC treated with trastuzumab between January 2008 and June 2009 at 10 Italian institutions were followed for 1 year. We evaluated incidence, time of occurrence, and clinical features associated with Tcardiotox. Left ventricular ejection fraction (LVEF) was evaluated by echocardiography at baseline and at 3, 6, 9, and 12 months during trastuzumab therapy. Tcardiotox was recognized in 133 patients (27%): 102 (20%) showed asymptomatic reduction in LVEF of >10% but <=20% (grade 1 Tcardiotox); 15 (3%) had asymptomatic decline of LVEF of >20% or <50% (grade 2); and 16 (3%) had symptomatic heart failure (grade 3). Trastuzumab was discontinued due to cardiotoxicity in 24 patients (5%) and restarted in 13 after LVEF recovery. Forty-one percent of Tcardiotox cases occurred within the first 3 months of follow-up, most prevalently in older patients with higher creatinine levels and in patients pretreated with doxorubicin and radiotherapy. CONCLUSIONS: In clinical practice ,Tcardiotox is frequent in HER2-positive women with EBC and occurs in the first 3 months of therapy. Cardiac dysfunction is mild and asymptomatic in the majority of patients. The interruption of treatment is a rare event which occurs, however, in a significantly higher percentage than reported in randomized clinical trials. [ABSTRACT FROM AUTHOR]

Published
2012

7. Pharmacokinetics of VM 26 given intrapericardially or intravenously in patients with malignant pericardial effusion

Author

Figoli, F., Zanette, M. L., Tirelli, U., Sorio, R., Lestuzzi, C., Urso, R., Monfardini, S., and D'Incalci, M.

Abstract

Three patients with lung cancer (1 SCLC, 2 NSCLC) and pericardial malignant effusion received 100 mg/m2 Teniposide (VM 26) i.v. and, 1 week later, 50 mg/m2 intrapericardially. Plasma, pericardial, and urine levels of the drug were measured in all patients after the two treatments by a HPLC assay. After intrapericardial administration, a high VM 26 concentration was found in the pericardial cavity and slow systemic drug absorption was observed. Since the drug AUC after intrapericardial administration was approximately 15–21 times that after i.v. administration, it could be that this treatment is more effective against neoplastic deposits localized in the pericardium. Even though this small series does not permit conclusions to be drawn on the efficacy of VM 26 given intrapericardially, the lack of local toxicity, minimal systemic toxicity, and the response observed in two out of three patients given intrapericardial VM 26 suggest that further investigation should be carried out on this method of VM 26 administration.

Published
1987
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8. Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area

Author

Caiani, EG, Pellegrini, A, Carminati, MC, Lang, RM, Auricchio, A, Vaida, P, Obase, K, Sakakura, T, Komeda, M, Okura, H, Yoshida, K, Zeppellini, R, Noni, M, Rigo, T, Erente, G, Carasi, M, Costa, A, Ramondo, BA, Thorell, L, Akesson-Lindow, T, Shahgaldi, K, Germanakis, I, Fotaki, A, Peppes, S, Sifakis, S, Parthenakis, F, Makrigiannakis, A, Richter, U, Sveric, K, Forkmann, M, Wunderlich, C, Strasser, RH, Djikic, D, Potpara, T, Polovina, M, Marcetic, Z, Peric, V, Ostenfeld, E, Werther-Evaldsson, A, Engblom, H, Ingvarsson, A, Roijer, A, Meurling, C, Holm, J, Radegran, G, Carlsson, M, Tabuchi, H, Yamanaka, T, Katahira, Y, Tanaka, M, Kurokawa, T, Nakajima, H, Ohtsuki, S, Saijo, Y, Yambe, T, Dalto, M, Romeo, E, Argiento, P, Dandrea, A, Vanderpool, R, Correra, A, Sarubbi, B, Calabro, R, Russo, MG, Naeije, R, Saha, S K, Warsame, T A, Caelian, A G, Malicse, M, Kiotsekoglou, A, Omran, A S, Sharif, D, Sharif-Rasslan, A, Shahla, C, Khalil, A, Rosenschein, U, Erturk, M, Oner, E, Kalkan, AK, Pusuroglu, H, Ozyilmaz, S, Akgul, O, Aksu, HU, Akturk, F, Celik, O, Uslu, N, Bandera, F, Pellegrino, M, Generati, G, Donghi, V, Alfonzetti, E, Guazzi, M, Rangel, I, Goncalves, A, Sousa, C, Correia, AS, Martins, E, Silva-Cardoso, J, Macedo, F, Maciel, MJ, Lee, S, Kim, W, Yun, H, Jung, L, Kim, E, Ko, J, Enescu, OA, Florescu, M, Rimbas, RC, Cinteza, M, Vinereanu, D, Kosmala, W, Rojek, A, Cielecka-Prynda, M, Laczmanski, L, Mysiak, A, Przewlocka-Kosmala, M, Liu, D, Hu, K, Niemann, M, Herrmann, S, Cikes, M, Gaudron, PD, Knop, S, Ertl, G, Bijnens, B, Weidemann, F, Saravi, M, Tamadoni, AHMAD, Jalalian, ROZITA, Hojati, MOSTAF, Ramezani, SAEED, Yildiz, A, Inci, U, Bilik, MZ, Yuksel, M, Oyumlu, M, Kayan, F, Ozaydogdu, N, Aydin, M, Akil, MA, Tekbas, E, Shang, Q, Zhang, Q, Fang, F, Wang, S, Li, R, Lee, A PW, Yu, CM, Mornos, C, Ionac, A, Cozma, D, Popescu, I, Ionescu, G, Dan, R, Petrescu, L, Sawant, AC, Srivatsa, SV, Adhikari, P, Mills, PK, Srivatsa, SS, Boshchenko, A, Vrublevsky, A, Karpov, R, Trifunovic, D, Stankovic, S, Vujisic-Tesic, B, Petrovic, M, Nedeljkovic, I, Banovic, M, Tesic, M, Petrovic, M, Dragovic, M, Ostojic, M, Zencirci, E, Esen Zencirci, A, Degirmencioglu, A, Karakus, G, Ekmekci, A, Erdem, A, Ozden, K, Erer, HB, Akyol, A, Eren, M, Zamfir, D, Tautu, O, Onciul, S, Marinescu, C, Onut, R, Comanescu, I, Oprescu, N, Iancovici, S, Dorobantu, M, Melao, F, Pereira, M, Ribeiro, V, Oliveira, S, Araujo, C, Subirana, I, Marrugat, J, Dias, P, Azevedo, A, study, EURHOBOP, Grillo, M T, Piamonti, B, Abate, E, Porto, A, Dellangela, L, Gatti, G, Poletti, A, Pappalardo, A, Sinagra, G, Pinto-Teixeira, P, Galrinho, A, Branco, L, Fiarresga, A, Sousa, L, Cacela, D, Portugal, G, Rio, P, Abreu, J, Ferreira, R, Fadel, B, Abdullah, N, Al-Admawi, M, Pergola, V, Bech-Hanssen, O, Di Salvo, G, Tigen, M K, Pala, S, Karaahmet, T, Dundar, C, Bulut, M, Izgi, A, Esen, A M, Kirma, C, Boerlage-Van Dijk, K, Yamawaki, M, Wiegerinck, EMA, Meregalli, PG, Bindraban, NR, Vis, MM, Koch, KT, Piek, JJ, Bouma, BJ, Baan, J, Mizia, M, Sikora-Puz, A, Gieszczyk-Strozik, K, Lasota, B, Chmiel, A, Chudek, J, Jasinski, M, Deja, M, Mizia-Stec, K, Silva Fazendas Adame, P R, Caldeira, D, Stuart, B, Almeida, S, Cruz, I, Ferreira, A, Lopes, L, Joao, I, Cotrim, C, Pereira, H, Unger, P, Dedobbeleer, C, Stoupel, E, Preumont, N, Argacha, JF, Berkenboom, G, Van Camp, G, Malev, E, Reeva, S, Vasina, L, Pshepiy, A, Korshunova, A, Timofeev, E, Zemtsovsky, E, Jorgensen, P G, Jensen, JS, Fritz-Hansen, T, Biering-Sorensen, T, Jons, C, Olsen, NT, Henri, C, Magne, J, Dulgheru, R, Laaraibi, S, Voilliot, D, Kou, S, Pierard, L, Lancellotti, P, Tayyareci, Y, Dworakowski, R, Kogoj, P, Reiken, J, Kenny, C, Maccarthy, P, Wendler, O, Monaghan, MJ, Song, JM, Ha, TY, Jung, YJ, Seo, MO, Choi, SA, Kim, YJ, Sun, BJ, Kim, DH, Kang, DH, Song, JK, Le Tourneau, T, Topilsky, Y, Inamo, J, Mahoney, D, Suri, R, Schaff, H, Enriquez-Sarano, M, Bonaque Gonzalez, JC, Sanchez Espino, AD, Merchan Ortega, G, Bolivar Herrera, N, Ikuta, I, Macancela Quinonez, JJ, Munoz Troyano, S, Ferrer Lopez, R, Gomez Recio, M, Dreyfus, J, Cimadevilla, C, Brochet, E, Himbert, D, Iung, B, Vahanian, A, Messika-Zeitoun, D, Izumo, M, Takeuchi, M, Seo, Y, Yamashita, E, Suzuki, K, Ishizu, T, Sato, K, Aonuma, K, Otsuji, Y, Akashi, YJ, Muraru, D, Addetia, K, Veronesi, F, Corsi, C, Mor-Avi, V, Yamat, M, Weinert, L, Lang, RM, Badano, LP, Minamisawa, M, Koyama, J, Kozuka, A, Motoki, H, Izawa, A, Tomita, T, Miyashita, Y, Ikeda, U, Florescu, C, Niemann, M, Liu, D, Hu, K, Herrmann, S, Gaudron, PD, Scholz, F, Stoerk, S, Ertl, G, Weidemann, F, Marchel, M, Serafin, A, Kochanowski, J, Piatkowski, R, Madej-Pilarczyk, A, Filipiak, KJ, Hausmanowa-Petrusewicz, I, Opolski, G, Meimoun, P, Mbarek, D, Clerc, J, Neikova, A, Elmkies, F, Tzvetkov, B, Luycx-Bore, A, Cardoso, C, Zemir, H, Mansencal, N, Arslan, M, El Mahmoud, R, Pilliere, R, Dubourg, O, Ikonomidis, I, Lambadiari, V, Pavlidis, G, Koukoulis, C, Kousathana, F, Varoudi, M, Tritakis, V, Triantafyllidi, H, Dimitriadis, G, Lekakis, I, Kovacs, A, Kosztin, A, Solymossy, K, Celeng, C, Apor, A, Faludi, M, Berta, K, Szeplaki, G, Foldes, G, Merkely, B, Kimura, K, Daimon, M, Nakajima, T, Motoyoshi, Y, Komori, T, Nakao, T, Kawata, T, Uno, K, Takenaka, K, Komuro, I, Gabric, I D, Vazdar, LJ, Pintaric, H, Planinc, D, Vinter, O, Trbusic, M, Bulj, N, Nobre Menezes, M, Silva Marques, J, Magalhaes, R, Carvalho, V, Costa, P, Brito, D, Almeida, AG, Nunes-Diogo, AG, Davidsen, E S, Bergerot, C, Ernande, L, Barthelet, M, Thivolet, S, Decker-Bellaton, A, Altman, M, Thibault, H, Moulin, P, Derumeaux, G, Huttin, O, Voilliot, D, Frikha, Z, Aliot, E, Venner, C, Juilliere, Y, Selton-Suty, C, Yamada, T, Ooshima, M, Hayashi, H, Okabe, S, Johno, H, Murata, H, Charalampopoulos, A, Tzoulaki, I, Howard, LS, Davies, RJ, Gin-Sing, W, Grapsa, J, Wilkins, MR, Gibbs, JSR, Castillo, JMDC, Bandeira, AMPB, Albuquerque, ESA, Silveira, C, Pyankov, V, Chuyasova, Y, Lichodziejewska, B, Goliszek, S, Kurnicka, K, Dzikowska Diduch, O, Kostrubiec, M, Krupa, M, Grudzka, K, Ciurzynski, M, Palczewski, P, Pruszczyk, P, Arana, X, Oria, G, Onaindia, JJ, Rodriguez, I, Velasco, S, Cacicedo, A, Palomar, S, Subinas, A, Zumalde, J, Laraudogoitia, E, Saeed, S, Kokorina, MV, Fromm, A, Oeygarden, H, Waje-Andreassen, U, Gerdts, E, Gomez, ELENA, Vallejo, NURIA, Pedro-Botet, LUISA, Mateu, LOURDE, Nunyez, RAQUEL, Llobera, LAIA, Bayes, ANTONI, Sabria, MIQUEL, Antonini-Canterin, F, Mateescu, AD, La Carrubba, S, Vriz, O, Di Bello, V, Carerj, S, Zito, C, Ginghina, C, Popescu, BA, Nicolosi, GL, Mateescu, AD, La Carrubba, S, Vriz, O, Di Bello, V, Carerj, S, Zito, C, Ginghina, C, Popescu, BA, Nicolosi, GL, Antonini-Canterin, F, Pudil, R, Praus, R, Vasatova, M, Vojacek, J, Palicka, V, Hulek, P, P37/03, Prvouk, Pradel, S, Mohty, D, Damy, T, Echahidi, N, Lavergne, D, Virot, P, Aboyans, V, Jaccard, A, Mateescu, AD, La Carrubba, S, Vriz, O, Di Bello, V, Carerj, S, Zito, C, Ginghina, C, Popescu, BA, Nicolosi, GL, Antonini-Canterin, F, Doulaptsis, C, Symons, R, Matos, A, Florian, A, Masci, PG, Dymarkowski, S, Janssens, S, Bogaert, J, Lestuzzi, C, Moreo, A, Celik, S, Lafaras, C, Dequanter, D, Tomkowski, W, De Biasio, M, Cervesato, E, Massa, L, Imazio, M, Watanabe, N, Kijima, Y, Akagi, T, Toh, N, Oe, H, Nakagawa, K, Tanabe, Y, Ikeda, M, Okada, K, Ito, H, Milanesi, O, Biffanti, R, Varotto, E, Cerutti, A, Reffo, E, Castaldi, B, Maschietto, N, Vida, VL, Padalino, M, Stellin, G, Bejiqi, R, Retkoceri, R, Bejiqi, H, Retkoceri, A, Surdulli, SH, Massoure, PL, Cautela, J, Roche, NC, Chenilleau, MC, Gil, JM, Fourcade, L, Akhundova, A, Cincin, A, Sunbul, M, Sari, I, Tigen, MK, Basaran, Y, Suermeci, G, Butz, T, Schilling, IC, Sasko, B, Liebeton, J, Van Bracht, M, Tzikas, S, Prull, MW, Wennemann, R, Trappe, HJ, Attenhofer Jost, C H, Pfyffer, M, Scharf, C, Seifert, B, Faeh-Gunz, A, Naegeli, B, Candinas, R, Medeiros-Domingo, A, Wierzbowska-Drabik, K, Roszczyk, N, Sobczak, M, Plewka, M, Krecki, R, Kasprzak, JD, Ikonomidis, I, Varoudi, M, Papadavid, E, Theodoropoulos, K, Papadakis, I, Pavlidis, G, Triantafyllidi, H, Anastasiou - Nana, M, Rigopoulos, D, Lekakis, J, Tereshina, O, Surkova, E, Vachev, A, Merchan Ortega, G, Bonaque Gonzalez, JC, Sanchez Espino, AD, Bolivar Herrera, N, Bravo Bustos, D, Ikuta, I, Aguado Martin, MJ, Navarro Garcia, F, Ruiz Lopez, F, Gomez Recio, M, Merchan Ortega, G, Bonaque Gonzalez, JC, Bravo Bustos, D, Sanchez Espino, AD, Bolivar Herrera, N, Bonaque Gonzalez, JJ, Navarro Garcia, F, Aguado Martin, MJ, Ruiz Lopez, MF, Gomez Recio, M, Eguchi, H, Maruo, T, Endo, K, Nakamura, K, Yokota, K, Fuku, Y, Yamamoto, H, Komiya, T, Kadota, K, Mitsudo, K, Nagy, A I, Manouras, AI, Gunyeli, E, Shahgaldi, K, Winter, R, Hoffmann, R, Barletta, G, Von Bardeleben, S, Kasprzak, J, Greis, C, Vanoverschelde, J, Becher, H, Hu, K, Liu, D, Niemann, M, Herrmann, S, Cikes, M, Gaudron, PD, Knop, S, Ertl, G, Bijnens, B, Weidemann, F, Di Salvo, G, Al Bulbul, Z, Issa, Z, Khan, AM, Faiz, AA, Rahmatullah, SH, Fadel, BM, Siblini, G, Al Fayyadh, M, Menting, M E, Van Den Bosch, AE, Mcghie, JS, Cuypers, JAAE, Witsenburg, M, Van Dalen, BM, Geleijnse, ML, Roos-Hesselink, JW, Olsen, FJ, Jorgensen, PG, Mogelvang, R, Jensen, JS, Fritz-Hansen, T, Bech, J, Biering-Sorensen, T, Agoston, G, Pap, R, Saghy, L, Forster, T, Varga, A, Scandura, S, Capodanno, D, Dipasqua, F, Mangiafico, S, Caggegi, A M, Grasso, C, Pistritto, A M, Imme, S, Ministeri, M, Tamburino, C, Cameli, M, Lisi, M, Dascenzi, F, Cameli, P, Losito, M, Sparla, S, Lunghetti, S, Favilli, R, Fineschi, M, Mondillo, S, Ojaghihaghighi, Z, Javani, B, Haghjoo, M, Moladoust, H, Shahrzad, S, Ghadrdoust, B, Altman, M, Aussoleil, A, Bergerot, C, Bonnefoy-Cudraz, E, Derumeaux, G A, Thibault, H, Shkolnik, E, Vasyuk, Y, Nesvetov, V, Shkolnik, L, Varlan, G, Gronkova, N, Kinova, E, Borizanova, A, Goudev, A, Saracoglu, E, Ural, D, Sahin, T, Al, N, Cakmak, H, Akbulut, T, Akay, K, Ural, E, Mushtaq, S, Andreini, D, Pontone, G, Bertella, E, Conte, E, Baggiano, A, Annoni, A, Formenti, A, Fiorentini, C, Pepi, M, Cosgrove, C, Carr, L, Chao, C, Dahiya, A, Prasad, S, Younger, JF, Biering-Sorensen, T, Christensen, LM, Krieger, DW, Mogelvang, R, Jensen, JS, Hojberg, S, Host, N, Karlsen, FM, Christensen, H, Medressova, A, Abikeyeva, L, Dzhetybayeva, S, Andossova, S, Kuatbayev, Y, Bekbossynova, M, Bekbossynov, S, Pya, Y, Farsalinos, K, Tsiapras, D, Kyrzopoulos, S, Spyrou, A, Stefopoulos, C, Romagna, G, Tsimopoulou, K, Tsakalou, M, Voudris, V, Cacicedo, A, Velasco Del Castillo, S, Anton Ladislao, A, Aguirre Larracoechea, U, Onaindia Gandarias, J, Romero Pereiro, A, Arana Achaga, X, Zugazabeitia Irazabal, G, Laraudogoitia Zaldumbide, E, Lekuona Goya, I, Varela, A, Kotsovilis, S, Salagianni, M, Andreakos, V, Davos, CH, Merchan Ortega, G, Bonaque Gonzalez, JC, Sanchez Espino, AD, Bolivar Herrera, N, Macancela Quinones, JJ, Ikuta, I, Ferrer Lopez, R, Munoz Troyano, S, Bravo Bustos, D, and Gomez Recio, M

Abstract

Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease. The physiology of cardiac adaptation to deconditioning has not been fully elucidated. The purpose of the present study was to assess the effects of 21-days of strict head-down (-6 degrees) bed-rest (BR) deconditioning on left ventricular (LV) dimensions and mass measured by MRI. Methods: Ten healthy men (mean age 32±6) were enrolled; the experiment was conducted at DLR (Koln, Germany) as part of the European Space Agency BR studies. Steady-state free precession MRI images (7mm thickness, no gap, no overlap) were obtained (Symphony 1.5T, Siemens) in a stack of short-axis views from LV base to LV apex, before (PRE), at the end of BR (HDT20), and four days after the BR conclusion (POST). Endocardial and epicardial semi-automated contouring was performed using freely available software (Segment). Results: At HDT20, significant reductions in LV mass (16%), end-diastolic (26%) and end-systolic (27%) volumes and stroke volume (27%) were observed, while ejection fraction did not change. These changes were accompanied by a measured decrease (14%) in plasma and blood volume (by gas-rebreathing technique), as well as by a significant reduction (14%) in VO2max aerobic power, measured using a graded cycle ergometer test protocol to volitional fatigue, at one day after the BR conclusion, while expiratory exchange ratio did not change. At POST, LV volumes were restored, while LV mass was still trending towards control values. Conclusions: Cardiac adaptation to deconditioning affected LV mass and dimensions, as a combined result of LV remodeling and fluids loss, accompanied by worsening in aerobic power. This should be taken into account in patients with cardiovascular diseases, when immobilized in bed, to proper adjust the therapy, or to define appropriate physical exercises when possible, in order to avoid further complications.   Cardiac MRI parameters PREHDT20POSTLV mass (g)121±6102±11*114±16End-diastolic volume (ml)119±2590±14*118±25End-systolic volume (ml)42±831±8*45±14Stroke volume (ml)76±2259±11*73±15Ejection fraction (%)64±665±762±7 *: p<.01 vs PRE (one-way Anova for paired data and Tukey test)

Published
2013
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