Fatal progressive right heart failure in a pancreatic cancer patient

Byoun, Jeong Tae; Cho, Jae Young

doi:10.12701/yujm.2019.00332

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…First described in 1990 by von Herbay et al [1], PTTM is known as a rare complication of cancer. It is called as "paraneoplastic syndrome" by some authors [2,3]. As PTTM progresses, the proliferation of pulmonary arterial endothelium and hypercoagulation occurs.…”

Section: Discussionmentioning

confidence: 99%

“…Tumour cells travel through pulmonary arteries and obstruct small pulmonary vessels, causing substantial reduction of pulmonary circulation [1,2]. PTTM causes pulmonary hypertension (PH), respiratory Neverauskaite-Piliponiene et al BMC Cardiovascular Disorders (2022) 22:1 failure leading to death due to the right heart failure [3]. Pathologically, major role is played by factors expressed by tumour cells-vascular endothelial growth factor (VEGF), tissue factor (TF) and platelet-derived growth factor (PDGF) [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Fatal pulmonary tumour thrombotic microangiopathy in patient with ovarian adenocarcinoma: review and a case report

Neverauskaite-Piliponiene

Cesas

Pranys

et al. 2022

BMC Cardiovasc Disord

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Background Pulmonary tumour thrombotic microangiopathy (PTTM) is a fatal disease in which tumour cells embolize to the pulmonary vasculature leading to pulmonary hypertension and right heart failure. Early diagnosis is essential for timely treatment which can reduce intimal pulmonary vascular proliferation and prolong survival, improve the symptoms. Due to rare occurrences and no clear diagnostic guidelines the disorder usually is found post-mortem. We present a review of this rare disease and a case of post-mortem diagnosed pulmonary tumour thrombotic microangiopathy in a young female. Case presentation 51 years old woman presented with progressively worsening dyspnea, right ventricular failure signs and symptoms. Computerized tomography denied pulmonary embolism. 2D transthoracic echocardiography demonstrated right ventricle dilatation and dysfunction, severely increased systolic pulmonary pressure. Right heart catheterization revealed pre-capillary pulmonary hypertension with mean pulmonary artery pressure of 78 mmHg, pulmonary wedge pressure of 15 mmHg, reduced cardiac output to 1.78 L/min with a calculated pulmonary vascular resistance of 35 Wood units, and extremely low oxygen saturation (26%) in pulmonary artery. Because of worsening ascites, pelvic magnetic resonance imaging was performed, tumours in both ovaries were diagnosed. Due to the high operative risk, detailed tumour diagnosis surgically was not established. The patient developed progressive cardiorespiratory failure, unresponsive to optimal heart failure drug treatment. A postmortem morphology analyses revealed tumorous masses in pre-capillary lung vessels, right ventricle hypertrophy, ovary adenocarcinoma. Conclusions An early diagnosis of PTTM is essential. Most cases are lethal due to respiratory failure progressing rapidly. Patients with a history of malignancy, symptoms and signs implying of PH should be considered of having PTTM. If detected early enough, combination of chemotherapy with specific PH therapy is believed to be beneficial in reducing intimal proliferation and prolonging survival, along with improving the symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fatal pulmonary tumour thrombotic microangiopathy in patient with ovarian adenocarcinoma: review and a case report

Neverauskaite-Piliponiene

Cesas

Pranys

et al. 2022

BMC Cardiovasc Disord

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“…Pancreatic cancer can manifest a variety of thromboembolic diseases, such as pulmonary embolism, deep venous thrombosis, disseminated intravascular coagulation, portal venous thrombosis, and arterial thromboembolism. Venous thromboembolism, which is a result of coagulation cascade activation, enhanced tumor growth, and angiogenesis, can directly lead to the formation of distal thrombi, eventually causing pulmonary emboli [ 68 , 75 ]. Pulmonary tumor emboli (PTE) are unusually seen in patients with cancer.…”

Section: Pancreatic-cancer-related Coagulopathy and The Heartmentioning

confidence: 99%

Prospective of Pancreatic Cancer Diagnosis Using Cardiac Sensing

et al. 2023

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Pancreatic carcinoma (Ca Pancreas) is the third leading cause of cancer-related deaths in the world. The malignancies of the pancreas can be diagnosed with the help of various imaging modalities. An endoscopic ultrasound with a tissue biopsy is so far considered to be the gold standard in terms of the detection of Ca Pancreas, especially for lesions <2 mm. However, other methods, like computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI), are also conventionally used. Moreover, newer techniques, like proteomics, radiomics, metabolomics, and artificial intelligence (AI), are slowly being introduced for diagnosing pancreatic cancer. Regardless, it is still a challenge to diagnose pancreatic carcinoma non-invasively at an early stage due to its delayed presentation. Similarly, this also makes it difficult to demonstrate an association between Ca Pancreas and other vital organs of the body, such as the heart. A number of studies have proven a correlation between the heart and pancreatic cancer. The tumor of the pancreas affects the heart at the physiological, as well as the molecular, level. An overexpression of the SMAD4 gene; a disruption in biomolecules, such as IGF, MAPK, and ApoE; and increased CA19-9 markers are a few of the many factors that are noted to affect cardiovascular systems with pancreatic malignancies. A comprehensive review of this correlation will aid researchers in conducting studies to help establish a definite relation between the two organs and discover ways to use it for the early detection of Ca Pancreas.

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“…Pancreatic cancer is one of the most aggressive cancers ranking fourth in lethality, with a 5‐year survival rate of less than 10%, and has limited diagnostic and therapeutic options (Herreros‐Villanueva et al, 2012 ; Perkail et al, 2020 ). Several cases of heart failure have been reported in patients with pancreatic cancer (Byoun & Cho, 2020 ; Nunnery et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Evidence of sex differences in cancer‐related cardiac complications in mouse models of pancreatic and liver cancer

Gams

Nevarez

Perkail

et al. 2023

Physiological Reports

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Abnormal heart rate variability (HRV) is commonly observed in cancer patients who have undergone targeted therapy and/or surgery, yet the effects of cancer itself on cardiac function remain underexplored. Specifically, there is limited knowledge about sex‐specific manifestations of HRV in cancer patients. Transgenic mouse models are widely used to study different types of cancer. Here, we aimed to investigate the sex‐specific effects of cancer on cardiac function using transgenic mouse models of pancreatic and liver cancers. This study used male and female transgenic mice with cancer and wild‐type controls. Cardiac function was assessed by recording electrocardiograms in conscious mice. RR intervals were detected to determine HRV using time and frequency domain analyses. Histological analysis with Masson's trichrome staining was performed to determine structural changes. In females, increased HRV was observed in both pancreatic and liver cancer‐bearing mice. In contrast, in males, increased HRV was observed only in the liver cancer group. Male pancreatic cancer mice demonstrated autonomic balance shift showing an increase in parasympathetic to sympathetic tone. The heart rate (HR) was higher in control and liver cancer male mice groups than in females. Histological analysis did not show significant sex differences but suggested a higher degree of remodeling in liver cancer mice than in control, specifically in the right atrium and left ventricle. This study revealed sex differences in cancer's HR modulation. Specifically, female cancer mice had lower median HR and higher HRV. These findings indicate that sex must be considered when using HRV as a cancer biomarker.

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Fatal progressive right heart failure in a pancreatic cancer patient

Cited by 4 publications

References 8 publications

Fatal pulmonary tumour thrombotic microangiopathy in patient with ovarian adenocarcinoma: review and a case report

Fatal pulmonary tumour thrombotic microangiopathy in patient with ovarian adenocarcinoma: review and a case report

Prospective of Pancreatic Cancer Diagnosis Using Cardiac Sensing

Evidence of sex differences in cancer‐related cardiac complications in mouse models of pancreatic and liver cancer

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