Bortezomib-induced Severe Congestive Heart Failure

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Cardiotoxicity is a known side effect of some anti-cancer drugs, necessitating cardiac monitoring.
• Bortezomib (Velcade) is a proteasome inhibitor used for multiple myeloma (MM), with cardiac failure incidence reported as incidental in clinical trials.
• Pre-existing cardiac conditions can be exacerbated by bortezomib, but new-onset cardiomyopathy is rare.

Observation:

• A 50-year-old female with newly diagnosed MM and no prior cardiac issues developed severe heart failure after two cycles of bortezomib and dexamethasone.
• Echocardiogram revealed dilated cardiomyopathy with significantly reduced left ventricular ejection fraction (LVEF).
• Coronary angiography excluded coronary artery disease, and findings were inconsistent with amyloid deposits or myocardial scarring.

Findings:

• The patient's heart failure was attributed to bortezomib, potentially due to fluid retention or disruption of the ubiquitin-proteasome system.
• This case highlights the possibility of bortezomib-induced cardiomyopathy, even in patients without pre-existing cardiac risk factors.

Implications:

• The ubiquitin-proteasome system disruption by bortezomib may be a mechanism for developing cardiomyopathy.
• Routine cardiac parameter monitoring is advised for patients undergoing bortezomib therapy for multiple myeloma.
• Early detection of cardiac side effects can improve patient outcomes and management strategies for MM treatment.