Maurizio Pesolo

We present the case of a 55–year–old hypertensive patient, with no other cardiovascular risk factors and no noteworthy cardiovascular history. Suffering from lymphoma, derived from grade I/II peripheral B lymphocytes, diagnosed in January 2018, underwent chemotherapy according to the R–CHOP scheme and continued until September 2021 with immunotherapy (Rituximab). The follow–up cardiological evaluation in September 2022 refers to dyspnoea for moderate exertion and some episodes of stinging chest pain, of short duration, not associated with neurovegetative symptoms. The Echocardiogram documented a left ventricular global systolic function at the lower limits of the norm evaluated with Eco3D (FE 53%). GLS –17.6%. ECG normal. A Coro–Tc was recommended and scheduled which documented the presence on the middle part of the anterior descending artery of partially calcified atheromatous plaque which extends for about 5 mm and which determines the reduction of the area by 67% and of the diameter of 70% therefore the patient underwent a coronary angiography with angioplasty with implantation of a medicated stent on IVA. This case demonstrates how important it is to perform a careful follow–up in cancer patients and how properly used imaging methods can help us in diagnosis and treatment.

We present a clinical case of a 19–year–old young athletic patient with reported episodes of heart palpitation. The baseline electrocardiogram was negative. Holter ECG documented: "16 single supraventricular extrasystoles normally conducted to the ventricles; 3877 polymorphic, single and repetitive, ventricular extrasystoles; 45 pairs and 4 triplets." In light of the Holter report, he underwent Exercise Testing that documented : "isolated and repetitive polymorphic BEVs, a few pairs and two 4 beats run nsVT " Since the patient had contracted SARS–COVID 19 infection about two months earlier, the first diagnostic hypothesis was to be referred to secondary myocarditis and therefore an indication for cardiac MRI was placed. Cardio–RM documented the presence of mesocardial and subepicardial fibrosis with Late Gadolinium Enhancement distribution pattern of non–ischemic type, in the mid–apical segments of the lateral wall of the left ventricle and in the lateral wall of the right ventricle at the outflow tract, findings compatible in first hypothesis with Arrhythmogenic Cardiomyopathy of the Right Ventricle.

Cardio–oncology is a recent rapid–developing multidisciplinary approach created by oncologists in accordance with cardiologists with the objective to minimize the adverse cardiovascular effects of contemporary cancer therapy and to maximize the benefits that can be obtained from it. Pre–treatment cancer therapy–related cardiovascular toxicity (CTR–CVT) risk assessment can be performed using HFA–ICOS risk assessment tools, in addition to a careful clinical history analysis, physical examination, ECG, biomarkers, and echocardiography. In our study, the analysis of standard and advanced echocardiographic parameters (left atrial strain or LAS, left ventricular global longitudinal strain or GLS, and 3D echocardiography) were performed at baseline, at three, six, and 12 months timepoints. A number of 53 female patients with breast cancer, scheduled to receive chemotherapy, was enrolled. All patients had basal 3D LVEF values ≥ 50% and a basal GLS > –18,5%. Statistically significant reductions (p15% of LASr reduction compared to baseline) after three months. Although atrial dysfunction was not statistically significant in predicting asymptomatic cardiotoxicity (p=0.12), patients with atrial dysfunction at three months have a 3,7 times greater risk of developing asymptomatic cardiotoxicity at 12 months. With our analysis, we found that HFA–ICOS risk score could be considered a predictor of cardiotoxicity at 12 months (p<001). Further studies will be conducted, in order to expand the population and to confirm our results. Open in new tab Download slide Open in new tab Download slide Open in new tab Download slide

Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.