Cisplatin-induced cardiotoxicity with midrange ejection fraction: A case report and review of the literature

Abstract

Rationale: Cisplatin monotherapy-induced cardiotoxicity is rare, and the prevalence remains unknown. It's extremely important to stop cisplatin when cardiotoxicity is considered.

Patient concerns: A 53-year-old woman developed cervical cancer. She was administered cisplatin (37 mg/m/wk) for 3 weeks, but the left ventricular ejection fraction (LVEF) declined from 70% to 48%.

Diagnosis: Electrocardiogram showed first-degree atrioventricular block and ST-segment depression by 0.05 mv on leads II, III, and V3-5. Neither cardiac markers nor N-terminal pro-B-type natriuretic peptide (NT-pro BNP) was elevated. After a careful physical examination and laboratory investigation, we confirmed that cervical cancer did not progress and no other cause was evident. So we figured cardiotoxicity might be induced by cisplatin.

Interventions: Cisplatin was stopped and cardioprotective therapies were given to the patient.

Outcomes: After discontinuing cisplatin and adding cardioprotective therapies, the LVEF increased to 50% and 53%, respectively (M-mode echocardiography) after 17 and 90 days, which further confirmed our diagnosis.

Lessons: According to this case and literature review, cisplatin-induced cardiotoxicity should be considered for the patient. When necessary, we should discontinue the suspected drug to confirm diagnosis. Cardioprotective therapies would minimize the drug-induced cardiovascular adverse events and improve patients' outcome.

Figure 1

Comparisons of echocardiographic findings before and after DDP use. LVEDD stands for left ventricular end-diastolic ejection fraction; LVFS stands for left ventricular fractional shortening; LVEF stands for left ventricular ejection fraction (M-mode); MPA stands for main pulmonary artery; IVC stands for inferior vena cava.

Figure 2

Parasternal short axis view at the mid-left ventricle (papillary muscle) of echocardiogram.