No abstract

Anthracyclines (anth) are potent antineoplasic agents, although, their efficacy is limited by cardiotoxicity. Most lymphoid malignancies tend to recur and commonly require anthracycline-based chemotherapy (anth-bch) re-treatment. Our aim is to compare the pretreatment left ventricle ejection fraction (lvef) and global longitudinal strain (gls) between patients (pts) with new diagnosis of lymphoma (lym) and pts with lym recurrence that were treated previously with anth-bch. Among pts referred to assess lvef and gls prior to start ttm, lym patients were selected and divided in two groups: pts with recurrent lymp previously treated with anth and pts with new diagnosis of lymp. Patients data, lvef and gls values were collected retrospectively. 96 pts data were analyzed (see table): 23 pts (24%) with previous anth ttm and 73 newly diagnosed pts. No differences were found in baseline characteristics. Pts who previously had been treated with anth-bch demonstrated significantly lower lvef than the other group and there were more patients with lvef in the normal lower limit. Gls was also lower but the difference was not significant. The fact that gls was not calculated in all patients may explain this finding. No differences were found in diastolic function. Previous cardiotoxic ttm and lower limit of normal lvef have been described as patient-related risk factors for developing cardiotoxicity. Currently, previous cardiotoxicity risk assessment is critical to allow preventive measures. Cardio-oncology units are crucial to address cardiovascular (cv) needs of cancer patients. * p < 0.05 Previous anthracycline No previous anthracycline p n (%) 23 ( 24 %) 73 ( 76%) Women, n (%) 9 (39%) 34 (47%) 0,31 Age (m +/- SD) 66,2 +/- 14,6 63,2 +/- 17,4 0,44 Arterial hypertension, n(%) 8 (35%) 26 (36%) 1 Diabetes, n (%) 5 (22%) 8 (10%) 0,29 Dyslipidemia, n (%) 7 (30%) 28 (37%) 0,62 ACE inhibitor, n (%) 2 (8,7%) 4 (5,5%) 0,62 Betablokers, n (%) 5 (22%) 19 (26%) 0,78 FEVI (Simpson)*, m +/- SD 57,3 +/- 7 62,7 +/- 6 0,0007 GLS -19,3 +/- 3 -20,2 +/- 3,7 0,52 LVEF < 55%* 5 (22%) 4 (5,5%) 0,03 Comparison between lymphoma patients treated previuosly with antrhacycline and with no previous cardiotoxic treatment.

We report the case of an 82-year-old woman, with personal history of hypertension, diabetes mellitus, dyslipemia and permanent atrial fibrillation. In 2013 aortic valve substitution surgery was performed with a mechanic prosthetic valve. In her last echocardiogram in May 2018 a mild double mitral lesion was detected, with a normal aortic valve functioning. In March of 2019 she was admitted in hospital with symptoms of heart failure and 38ºC fever. A transthoracic echocardiogram was performed, which revealed a vegetation in the native mitral valve that caused a severe mitral stenosis (area 0.64 cm2). In blood cultures Streptococcus gallolyticycus was isolated. In this situation, a tranesophagical echocardiogram was performed, which confirmed the diagnosis of an infective endocarditis in the native mitral valve. It also showed spontaneous echocontrast as well as a thrombus in the left atrial appendage, despite anticoagulant medication. Given these findings, antibiotic therapy was initiated and surgery programmed. Substitution of the native mitral valve for a biological prosthesis was made. In the transthoracic echocardiographic control the prosthesis was normal functioning. A colonoscopy was performed taking into account the strong association between Streptococcus gallolyticus and colonic lesions, which showed no abnormal findings. At the discharge the patient had no signs or symptoms suggestive of heart failure or infection. Streptococcus gallolytycus is included in the D group of Streptococci. Among hospitalized patients, this group accounts for approximately 5% of streptococcal bloodstream isolates. For humans, the gastrointestinal tract is the most frequent entry point, other potential sources include the hepatobiliary tree and the urinary tract. Clinical manifestations include bacteremia and endocarditis, which is usually highly destructive and frequently bivalvular. Bone infection, meningitis or peritonitis can also be present. Due to the frequent association between this microorganism and colonic neoplasm, colonoscopy is necessary to dismiss pathological findings. Typically D Streptococci can be treated with penicillins, ceftriaxone, carbapenems, vancomycin, daptomycin, and linezolid. The preferred regimen for streptococcal prosthetic valve endocarditis includes a beta-lactam combined with an aminoglycoside, to achieve synergistic effect. Abstract P867 Figure. Mitral stenosis

Metastases to the heart and pericardium are discovered at autopsy in 10%–12% of all patients with malignancies. The most common primary tumor involving the pericardium is lung cancer, followed by breast, melanoma, and lymphoma. Pericardial effusion may be the result of the tumor spreading to the visceral pericardium which increases production of fluid, or accumulation of the fluid due to the obstruction of venous and lymphatic outflow. A malignant pericardial effusion is associated with decreased survival rate. We present a 72 year-old woman, former smoker with dyslipidemia and psoriatic arthritis as well as previous bladder carcinoma that was healed in 1986. On august 2017 after an acute intestinal obstruction she was diagnosed with stage IV ileum adenocarcinoma treated initially with palliative chemotherapy (Capecitabine and oxaliplatin) that was suspended for poor tolerance and according to patient desire. Few months later the patient complained of rapidly progressive dyspnoea that prevented her normal life activity, arterial pressure and blood oxygen saturation was normal, but she was tachycardic. Echocardiogram was performed (see figure) which showed marked pericardial nodular thickening and severe pericardial effusion with echocardiographic signs of cardiac tamponade. Curiously, pericardial effusion was dense and markedly hyperechogenic. A computed tomography (CT) was performed to rule out pericardial carcinomatosis and find out the pericardial fluid composition and demostrated several pericardial nodular thickenings that suggested metastases. The pericardial fluid was dense (40 hounsfield units) and consistent with blood. After multidispiplinar consultation and in accordance with patients wishes a palliative pericardial window was performed and hematic pericardial fluid was obtained. Pericardial liquid citology demonstrates atipical cells compatible with carcinoma and pericardial biospy showed fibrinous pericarditis and reactive mesothelial hyperplasia. Pericardial carcinomatosis consists of macroscopic or microscopic affection of pericardial layers. Metastasis from colorectal cancer to the pericardium is uncommon, and usually indicates terminal stage with multiple metastases, only a few cases have been reported. Malignant Pericardial effusions in patients with cancer may also be triggered by other mechanism than cancer itself, including chemotherapy, radiation therapy, and, less commonly, an infectious disease. Whereas echocardiography is most frequently used to examine the heart and pericardium, multimodaliy imaging with magnetic resonance (MR) or/and CT offer advantages when dealing with metastatic disease. Abstract 1101 Figure. Echocardiogram and CT images