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Abstract
Introduction. The article describes a clinical case of the development of dilated cardiomyopathy against the background of receiving antitumor therapy. Patient S, a 41-year-old female, presented to a cardiologist on 02.12.21 with complaints of shortness of breath when walking and swelling of the legs. She did not report any connection with infectious diseases or the appearance of shortness of breath. Prior to this, she underwent treatment at an oncology clinic with a diagnosis of stage IV ovarian cancer (T3cN1M1) with metastases in the mediastinal and retroperitoneal lymph nodes. After 6 courses of neoadjuvant autolymphochemotherapy with carboplatin and paclitaxel, on 11.04.2018 a complete cytoreductive surgery was performed, including hysterectomy with appendages, omentectomy, and cholecystectomy, followed by 6 courses of adjuvant polychemotherapy with carboplatin and paclitaxel.
Aim. To investigate the relationship between the development of dilated cardiomyopathy in the patient and chemotherapy.
Materials and methods. Echocardiography, contrast-enhanced cardiac MRI.
Results. Echocardiography performed on 02.12.21 revealed dilation of the left atrium up to 44 × 48 mm, right ventricle 26 mm, right atrium 45 × 40 mm, and left ventricle with a left ventricular end-diastolic volume of 255 ml and a left ventricular ejection fraction of 25-28 %. Cardiac MRI showed intramural contrast accumulation and delayed washout in the interventricular septum and the area of its connection with the free wall of the right ventricle, indicating myocardial damage. After three months of treatment with metoprolol succinate, sacubitril/valsartan, acetylsalicylic acid, spironolactone, torasemide, and empagliflozin, the patient showed clinical improvement and positive dynamics, including a decrease in the size of the left atrium to 40 × 43 mm, right ventricle to 25 mm, right atrium to 41 × 33 mm, and left ventricular end-diastolic volume to 190 ml, and an increase in the left ventricular ejection fraction to 44-46 %.
Conclusion. The key element for high-risk patients is the implementation of preventive measures to prevent possible cardiotoxic effects of chemotherapy drugs and the search for optimal therapy aimed at eliminating the negative consequences of chemotherapy.
References
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