P172 A RARE CASE OF PLATINUM CARDIOTOXICITY: CASE REPORT

Abstract

Abstract Background The chemotherapy regime containing the Carboplatin–Gemcitabine combination is frequently used for improving outcomes in patients affected by metastatic breast cancer. Platinum compounds were included in the recent ESC Guidelines on cardio–oncology as potential agents which may lead to myocardial infarction, thrombosis and, rarely, heart failure. In this instance it is essential for a strict cardiological follow–up to be carried out during and after treatment. Case report: We present a clinical case report of a 38–year–old woman who was receiving standard oncology treatment for stage IV breast adenocarcinoma. The patient underwent chemotherapy cycles containing the Carboplatin–Gemcitabine combination, with a good response to treatment. It came to our attention for severe dyspnoea, which arose several days before, not compatible with her oncological situation. Transthoracic echocardiography showed severe left ventricular dysfunction (EF 25%; GLS – 9.2%; NT–proBNP 10000 pg/mL), which was not present during earlier tests, and circumferential pericardial effusions, mainly localised along the free wall of the right ventricle, non–haemodynamically significant. Lung ultrasound also showed the presence of pulmonary congestion and bilateral pleural effusions. In the circumstances, she was admitted to the Cardiac Intensive Care Unit for continuation of diagnostic treatment. She then received endo–venous diuretic treatment and haemodynamically supported with Noradrenaline and inotropic agents. A cycle of Levosimendan was performed with an excellent response. Once haemodynamic compensation was re–established, the patient underwent a cardiac CMR which excluded cardiomyopathies and myocarditis and a coronarography was performed which showed no significant lesions in the coronary arteries. After 18 days of hospitalisation in our department, the patient showed an improvement in EF (EF 38%, GLS –12.5%, NT–proBNP 2000 pg/mL), and then she was referred to the oncologist for immunological treatment. Conclusions The diagnosis of cardiotoxicity may not be straightforward due to the aspecificity of the symptoms, its silent progression or because of several comorbidities. Moreover, cardiac damage from chemotherapy is considered reversible if identified early. Treatment is based on the withdrawal of therapy and treatment of symptoms, given that these may be different and unpredictable.