A rare case of Takotsubo cardiomyopathy.

BACKGROUND: The recent advent of the cyclin-dependent kinase (CDK) 4/6 inhibitors has considerably evolved hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer treatment. Palbociclib, an orally administered pyridopyrimidine derivative, was the first CDK4/6 inhibitor to be introduced into daily clinical practice in combination with classic endocrine backbone, based on progression-free survival (PFS) benefit assessed in the pivotal PALOMA series of randomized clinical trials. Regarding its safety profile, neutropenia and leukopenia are the most common and well-defined adverse effects, while cardiac complications are rather scarce. CASE REPORT: We present the rare case of a middle-aged female patient with HR+/HER2- metastatic breast cancer, without prior exposure to cardiotoxic antineoplastic agents, who developed Takotsubo cardiomyopathy (TTC) in the context of systemic therapy with palbociclib plus letrozole combination. CONCLUSIONS: Pharmacovigilance and experimental studies are warranted to confirm any causative relationship and to explore the underlying pathophysiology, respectively.

24 h blood pressure profile affects the left ventricle independently of the pressure level. A study in untreated essential hypertension diagnosed by office blood pressure readings.

This work examines whether the 24 h blood pressure (BP) pattern per se might affect the left ventricular structure independently of the pressure level. One hundred subjects with abnormally high office BP readings who had never received any antihypertensive treatment were submitted to 24 h ambulatory BP monitoring and left ventricular echocardiographic assessment. They were classified into two groups, as follows: dippers (group 1), consisting of 46 subjects whose mean nighttime systolic BP was reduced by at least 10% in comparison to the corresponding daytime value, and nondippers (group 2), consisting of 54 subjects whose nighttime BP did not drop or was reduced by < 10%. Left ventricular mass and end-diastolic volume values, both normalized for body surface area, were significantly higher in nondippers (r = 3.12, P < .003, and r = 7.46, P < .001, respectively). The two groups did not differ in diastolic thickness of either intraventricular septum or left ventricular posterior wall (both values normalized for body surface area), in mean 24 h systolic or diastolic or average blood pressure, or in age. In conclusion, in untreated essential hypertension diagnosed on the basis of abnormal office BP readings, the higher incidence of left ventricular mass increase in subjects unable to reduce their blood pressure during the night was more due to left ventricular dilatation than to myocardial wall thickening. The effect of the 24 h BP profile on left ventricular volume appears to be independent of both the BP level and age.

Detection of coronary artery disease in the presence of left ventricular atrophy.

To evaluate the accuracy of exercise echocardiography for the recognition of coronary artery disease in the presence of left ventricular hypertrophy 70 patients were studied. Significant coronary artery disease was present in 25 patients and left ventricular hypertrophy had 29 patients. All patients underwent an exercise ECG and echocardiographic test during which cine-loop digitized echocardiography was obtained. Wall motion was analyzed and a regional wall motion score index was calculated. The overall sensitivities of exercise ECG and echocardiography for detecting coronary artery disease were 60% and 64%, respectively, and the specificities were 49% and 78%, respectively. In patients with left ventricular hypertrophy the specificity of exercise echocardiography was higher (71%) compared to exercise ECG (21%) while in patients without hypertrophy the sensitivity was higher (70% vs. 40%, respectively). Of the 19 patients with a non-diagnostic stress ECG, echocardiography correctly identified 100% of those with coronary artery disease but only 53% of those without disease. It is concluded that exercise digital echocardiography represents a good diagnostic alternative to the exercise ECG for identifying coronary artery disease in the presence of left ventricular hypertrophy and should be useful in patients with a non-diagnostic exercise ECG.