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Temporary left ventricular assist device for complete recovery from reversible acute heart failure due to tumor necrosis factor-α inhibitor

We present the case of a 38-year-old woman with symptoms of acute heart failure (HF). In the previous months, she received tumor necrosis factor (TNF)-α inhibitors for the treatment of arthritis secondary to Crohn’s disease. She initially received etanercept (Enbrel) for nearly 1 year and subsequent...

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Published in:Anatolian journal of cardiology 2019-07, Vol.22 (1), p.46-48
Main Authors: Soucy-Giguere, Marie-Camille, Charbonneau, Éric, Cinq Mars, Alexandre, Dubois, Michelle, Sénéchal, Mario
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container_title Anatolian journal of cardiology
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creator Soucy-Giguere, Marie-Camille
Charbonneau, Éric
Cinq Mars, Alexandre
Dubois, Michelle
Sénéchal, Mario
description We present the case of a 38-year-old woman with symptoms of acute heart failure (HF). In the previous months, she received tumor necrosis factor (TNF)-α inhibitors for the treatment of arthritis secondary to Crohn’s disease. She initially received etanercept (Enbrel) for nearly 1 year and subsequently received infliximab (Remicade) for 6 months. Echocardiograms following the etanercept therapy were normal. Since her disease did not respond well to etanercept, she received 16 treatments of infliximab, at the end of which HF symptoms developed, with rapid clinical deterioration. Her echocardiogram demonstrated dilated cardiomyopathy with severe biventricular dysfunction and left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF)
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In the previous months, she received tumor necrosis factor (TNF)-α inhibitors for the treatment of arthritis secondary to Crohn’s disease. She initially received etanercept (Enbrel) for nearly 1 year and subsequently received infliximab (Remicade) for 6 months. Echocardiograms following the etanercept therapy were normal. Since her disease did not respond well to etanercept, she received 16 treatments of infliximab, at the end of which HF symptoms developed, with rapid clinical deterioration. Her echocardiogram demonstrated dilated cardiomyopathy with severe biventricular dysfunction and left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) &lt;20% with severe functional mitral and tricuspid regurgitation. Her extensive diagnostic work-up, including pathological examination of endomyocardial biopsy, was normal. Despite optimal treatment of HF, her status did not improve, and a left ventricular assist device (LVAD, HeartMate II) was implanted. The evolution was unremarkable, and she rapidly recovered in the following months, with LVEF reaching ≥45%. Based on the patient’s clinical improvement and LVEF recuperation, LVAD was removed. Her functional status and LVEF remained stable after LVAD explantation. 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In the previous months, she received tumor necrosis factor (TNF)-α inhibitors for the treatment of arthritis secondary to Crohn’s disease. She initially received etanercept (Enbrel) for nearly 1 year and subsequently received infliximab (Remicade) for 6 months. Echocardiograms following the etanercept therapy were normal. Since her disease did not respond well to etanercept, she received 16 treatments of infliximab, at the end of which HF symptoms developed, with rapid clinical deterioration. Her echocardiogram demonstrated dilated cardiomyopathy with severe biventricular dysfunction and left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) &lt;20% with severe functional mitral and tricuspid regurgitation. Her extensive diagnostic work-up, including pathological examination of endomyocardial biopsy, was normal. Despite optimal treatment of HF, her status did not improve, and a left ventricular assist device (LVAD, HeartMate II) was implanted. The evolution was unremarkable, and she rapidly recovered in the following months, with LVEF reaching ≥45%. Based on the patient’s clinical improvement and LVEF recuperation, LVAD was removed. Her functional status and LVEF remained stable after LVAD explantation. 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The evolution was unremarkable, and she rapidly recovered in the following months, with LVEF reaching ≥45%. Based on the patient’s clinical improvement and LVEF recuperation, LVAD was removed. Her functional status and LVEF remained stable after LVAD explantation. Therefore, the very probable etiology of the precipitated HF was infliximab toxicity.</abstract><cop>Turkey</cop><pub>Kare Publishing</pub><pmid>31264660</pmid><doi>10.14744/AnatolJCardiol.2019.67124</doi><tpages>3</tpages><oa>free_for_read</oa></addata></record>
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source Publicly Available Content (ProQuest); PubMed Central
subjects Adult
Arthritis - drug therapy
Arthritis - etiology
Biopsy
Blood pressure
Cardiac arrhythmia
Cardiology
Cardiomyocytes
Cardiomyopathy
Cardiomyopathy, Dilated - complications
Cardiomyopathy, Dilated - diagnosis
Cardiomyopathy, Dilated - drug therapy
Cardiotonic Agents - therapeutic use
Case Reports
Clinical deterioration
Crohn Disease - complications
Crohn's disease
Ejection fraction
Electrocardiography
Etanercept - therapeutic use
Family medical history
Female
Furosemide - therapeutic use
Heart attacks
Heart failure
Heart Failure - chemically induced
Heart Failure - therapy
Heart-Assist Devices
Humans
Infliximab - adverse effects
Infliximab - therapeutic use
lvad
Milrinone - therapeutic use
Monoclonal antibodies
Necrosis
NMR
Nuclear magnetic resonance
Patients
Pulmonary arteries
Rheumatoid arthritis
tnf-alpha inhibitors
toxicity
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Tumor necrosis factor-TNF
Ultrasonic imaging
title Temporary left ventricular assist device for complete recovery from reversible acute heart failure due to tumor necrosis factor-α inhibitor
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