PMC9622946_01
Evolutionary changes in the ECG. (A) (First day-07.14 AM: ECG at initial presentation): tall, spiky T waves diffusely in the ECG. (B) (First day-07.57 PM): concave ST elevation in the inferior and lateral series of leads. (C) (First day- 22.09 PM): ST elevation in the inferior and lateral series of leads with terminally negative T waves. (D) (Second day- 06.50 AM): negative T waves in the inferior and lateral series of leads. (E) (Fifth day- 07.00 AM): normal electrocardiogram.
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ECG initially showed peaked T waves with no ST changes (Figure 1A). Rapid evolutionary changes on daily basis were still registered in the ECG, and on the 2nd day of therapy negative T waves were registered in the inferior and lateral leads (Figure 1D) while, on the 5th day of therapy, a normal ECG was registered (Figure 1E). Further oncological treatment was advised based on the opinion of the cardiology-oncology council (Supplementary Figure 1).
Coronary findings and IVUS (Fifth day of admission) (A) LAD, left anterior-descending coronary artery. (B) Cx, circumflex coronary artery; (C) RCA- right coronary artery.
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In addition, signs of plaque rupture, plaque erosion or thrombus were not found in either of all three coronary arteries (Figure 2).
CMR of the heart (Fifth day of admission). (A) Postcontrast LGE in medial septum on PSIR sequence, SAX. (B) Basal anteroseptal postcontrast LGE on PSIR sequence, SAX. (C) Basal septum LGE phenomenon as well as pericard LGE in basal and medial lateral wall on PSIR sequence, four chamber view. (D) Pathological postcontrast T1 mapping (values > 500 ms) in basal septum, on MOLLI sequence, SAX. (E) Pathological postcontrast T1 mapping (values > 500 ms) in medial segments of all walls, circumferentially, on MOLLI sequence, SAX. (F) Pathological precontrast T1 mapping (values > 1100 ms) in basal septum and lateral wall. LGE, Postcontrast late gadolinium enhancement; PSIR, Phase sensitive inversion recovery; SAX, short axis view; MOLLI, Modified Look Locker inversion recovery.
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According to radiologists and CMR findings, changes in the myocardium first correspond to changes in cardiotoxicity (Figure 3).
Assessment of LV function with TTE (On the fifth day of admission): LV systolic function was severely impaired, including impaired and asynergic longitudinal deformations that can be appriciated from speckle tracking analysis of apical 4- chamber (A), 2-chamber (B), and 3-chamber (C) views and globally from polar map (D). During the follow-up (eighteenth day), LV EF and longitudinal deformations significantly improved (E-H). LV, left ventricle; TTE, transthoracic echocardiography; EF, left ventricular ejection fraction.
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