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Early onset of coronary artery disease in young survivor after combined treatment of non-Hodgkin lymphoma

Session Clinical Case Corner 5 - Cardio-oncology pearls

Speaker Associate Professor Elena Shavarova

Event : Heart Failure 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease: Treatment, Revascularization
  • Session type : Clinical Case Posters

Authors : EK Shavarova (Moscow,RU), IA Chomova (Moscow,RU), VV Maiskov (Moscow,RU), ZD Kobalava (Moscow,RU)

Authors:
EK Shavarova1 , IA Chomova1 , VV Maiskov1 , ZD Kobalava1 , 1RUDN University - Moscow - Russian Federation ,

Citation:

Introduction: the success and continued progress of cancer control strategies have resulted in a rise in the number of long-term cancer survivors. Cardiovascular diseases are increasingly observed as late effects of B-cell Non-Hodgkin lymphoma treatment. 

Case report: a thirty five-years-old female without previous cardiovascular risk factors and established diseases was diagnosed with B-cell Non-Hodgkin lymphoma (CD20+, CD3-, CD79a, CD15-, LCA+), II BE stage in March of 2012. After six courses of R-CHOP the radiation therapy was done (total dose 40 Gy). In January of 2013 complete disappearance of all detectable clinical evidence of disease and disease-related symptoms presented before therapy (fever, lymphadenopathy, cough, dyspnea) were observed. Complete remission was confirmed by CT-scan and Immunohistochemistry assay. All clinical exams and CT-scan were repeated every 6 month, no relapse symptoms were identified. Arterial hypertension grade II (transient), obesity class I, dyslipidemia (LDL-cholesterol 3.44 mmol/l) were observed without intake of any medications.  In October of 2018 new onset angina (Canadian Cardiovascular Society class I – during intensive aerobic exercises in fitness club) occurred. Two weeks later the patient was hospitalized with acute coronary syndrome (Class III angina). Negative T-wave were registered on ECG in I, avL, V2-V6. Troponin I was 0.02 ng/ml at admission and 0.05 ng/ml after 6 h. Two-vessels disease (critical stenos?s of left main disease and proximal left arterial descending artery) were observed on coronary angiography. Stent was placed into left main stem with optimal results of PCI (TIMI III). No angina attack were registered in post-PCI period and during follow up. On echocardiography one month after PCI  – pulmonary hypertension grade I, concentric remodeling, ejection fraction >50%, LV global longitudinal strain was -19% (-14% in septal segments).  NT-proBNP level was 256 pg/ml.

Conclusion: anthracyclines therapy and exposure of the heart to ionizing radiation during non-Hodgkin lymphoma treatment increases the subsequent rate of ischemic heart disease. Echocardiography and functional stress tests should be recommended at long-term follow up of non-Hodgkin's lymphoma survivors, especially after combined anthracycline and radiation therapy.



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