Cobalt-induced cardiomyopathy – do circulating cobalt levels matter?

Abstract

Elevated levels of circulating cobalt ions have been linked with a wide range of systemic complications including neurological, endocrine, and cardiovascular symptoms. Case reports of patients with elevated blood cobalt ions have described significant cardiovascular complications including cardiomyopathy. However, correlation between the actual level of circulating cobalt and extent of cardiovascular injury has not previously been performed. This review examines evidence from the literature for a link between elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties and cardiomyopathy. Correlation between low, moderate, and high blood cobalt with cardiovascular complications has been considered. Elevated blood cobalt at levels over 250 µg/l have been shown to be a risk factor for developing systemic complications and published case reports document cardiomyopathy, cardiac transplantation, and death in patients with severely elevated blood cobalt ions. However, it is not clear that there is a hard cut-off value and cardiac dysfunction may occur at lower levels. Clinical and laboratory research has found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. Further work needs to be done to clarify the link between severely elevated blood cobalt ions and cardiomyopathy. Cite this article: Bone Joint Res 2021;10(6):340–347.

Too young for an acquired cardiomyopathy? Cobalt metallosis as a cardiac amyloidosis mimicker

“…Signs of metallosis appeared before any symptoms related to the hip prosthesis. Cobalt‐induced cardiomyopathy comprises a spectrum of cardiac abnormalities in patients with elevated cobalt circulating levels, with different thresholds being suggested in the literature: >250 or >300 μg/L 9 . Importantly, diagnosis is supported by the normalization of cardiac structure and function after exposure ceases and cobalt concentrations decline 1 …”

“…Circulating levels of cobalt should be interpreted in the patient's context 13,14 . Metallosis is usually clinically manifest if the circulating cobalt levels exceed 300 μg/L; however, cobalt‐induced cardiomyopathy can be diagnosed in patients with cobalt circulating levels exceeding 250 μg/L and suggestive cardiac abnormalities 9,14 . ECG, electrocardiogram; hs‐troponin, high‐sensitivity troponin; LVEF, left ventricular ejection fraction; NT‐proBNP, N‐terminal pro‐brain natriuretic peptide; TSH, thyroid‐stimulating hormone.…”

Are postoperative blood tests always required after lower limb arthroplasty?

“…We emphasize that blood tests provide useful information in the management and surveillance of TJR patients. 27 - 29 They can aid in the identification of postoperative complications. 30 , 31 Furthermore, postoperative laboratory tests should be ordered in symptomatic patients to avoid missing complications and clinical problems.…”

Heart failure heralded by hip pain: A case of cobalt cardiomyopathy after hip arthroplasty

“…No definitive diagnostic tool exists for cobalt-induced cardiomyopathy. While the majority of cases have serum cobalt levels >250 μg/L, others have exhibited levels as low as 13 μg/L; hence the serum level and its cardiotoxic effect is not strongly correlated [4]. On the other hand, ECG and cardiac imaging are sensitive but not specific.…”