Advertisement

Journal of Nuclear Cardiology

, Volume 24, Issue 4, pp 1350–1354 | Cite as

Frequent MUGA testing in a myeloma patient: A case-based ethics discussion

  • Sabha Bhatti
  • Robert C. Hendel
  • Juan Lopez-Mattei
  • Ronald G. Schwartz
  • Gilbert Raff
  • Andrew J. EinsteinEmail author
Original Article

Case Presentation

A 51-year-old African-American male with a history of relapsed refractory IgA lambda myeloma status post stem cell transplant and many salvage therapies was referred to the nuclear cardiology laboratory in June 2015 for equilibrium radionuclide ventriculography (multigated acquisition; MUGA) to evaluate left ventricular function since he was recently started on a new regimen, which includes the mitogen-activated protein kinase kinase inhibitor trametinib, a potentially cardiotoxic chemotherapeutic agent. His diagnosis of multiple myeloma was first made 7 years prior to presentation to the nuclear lab; at that time he had presented with anemia, hypercalcemia, back pain, lytic bone lesions on CT scan, and markedly elevated total protein and low albumin. Bone marrow biopsy confirmed the suspicion of multiple myeloma. He was initially seen at a local office and subsequently referred to a quaternary care center drawing myeloma patients from across the United States and...

Notes

Disclosure

Dr Schwartz reports serving on the speakers bureau for Astellas Dr Einstein reports receiving grant support to Columbia University for other research from GE Healthcare, Philips Healthcare, and Toshiba America Medical Systems.

Supplementary material

12350_2016_540_MOESM1_ESM.pptx (200 kb)
Supplementary material 1 (PPTX 200 kb)
12350_2016_540_MOESM2_ESM.mp3 (6.7 mb)
Supplementary material 2 (MP3 6833 kb)

References

  1. 1.
    VanRhee F, Szymonifka J, Anaissie E, et al. Total therapy 3 for multiple myeloma: Prognostic implications of cumulative dosing and premature discontinuation of VTD maintenance components, bortezomib, thalidomide and dexamethasone, relevant to all phases of therapy. Blood. 2010;116:1220–7.CrossRefGoogle Scholar
  2. 2.
    Kongbundansuk S, Hundley G. Noninvasive imaging of cardiovascular injury related to the treatment of cancer. J Am Coll Cardiol Imaging. 2014;7:824–38.CrossRefGoogle Scholar
  3. 3.
    Schwartz RG, Jain D, Storozynsky E. Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively. J Nucl Cardiol. 2013;20:443–64.CrossRefGoogle Scholar
  4. 4.
    Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patient during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2013;27:911–39.CrossRefGoogle Scholar
  5. 5.
    Jiji RS, Kramer CM, Salerno M. Non-invasive imaging and monitoring cardiotoxicity of cancer therapeutic drugs. J Nucl Cardiol. 2012;19:377–88.CrossRefGoogle Scholar
  6. 6.
    Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr. 2011;24:229–67.CrossRefGoogle Scholar
  7. 7.
    Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popović ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy. J Am Coll Cardiol. 2013;61:77–84.CrossRefGoogle Scholar
  8. 8.
    Kurt M, Shaikh KA, Peterson L, et al. Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort. J Am Coll Cardiol. 2009;53:802–10.CrossRefGoogle Scholar
  9. 9.
    Bellener NG, Davies LC, Francis JM, Coats AJ, Pennell DJ. Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2000;2:271–8.CrossRefGoogle Scholar
  10. 10.
    Debatin JF, Nadel SN, Paolini JF, et al. Cardiac ejection fraction: phantom study comparing cine MR imaging, radionuclide blood pool imaging, and ventriculography. J Magn Reson Imaging. 1992;2:135–42.CrossRefGoogle Scholar
  11. 11.
    Yusuf SW, Solhpour A, Banchs J, et al. Cardiac amyloidosis. Expert Rev Cardiovasc Ther. 2014;12:265–77.CrossRefGoogle Scholar
  12. 12.
    Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate use criteria for cardiac radionuclide imaging: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol. 2009;53:2201–29.CrossRefGoogle Scholar
  13. 13.
    Schwartz RG, McKenzie WB, Alexander J, et al. Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy: A seven year experience using serial radionuclide angiocardiography. Am J Med. 1987;82:1109–18.CrossRefGoogle Scholar
  14. 14.
    Lancellotti P, Nchimi A, Delierneux C, et al. Biological effects of cardiac magnetic resonance on human blood cells. Circ Cardiovasc Imaging. 2015;8:e003697.CrossRefGoogle Scholar
  15. 15.
    Adams MJ, Dozier A, Shore RE, et al. Breast cancer risk 55+ years after irradiation for an enlarged thymus and its implications for early childhood medical irradiation today. Cancer Epidemiol Biomarkers Prev. 2010;19:48–58.CrossRefGoogle Scholar
  16. 16.
    Adams MJ, Shore RE, Dozier A, et al. Thyroid cancer risk 40+ years after irradiation for an enlarged thymus: an update of the Hempelmann cohort. Radiat Res. 2010;174:753–62.CrossRefGoogle Scholar
  17. 17.
    Sadeghi M, Schwartz RG, Beanlands RS, with the Cardiovascular Council Board of Directors of the Society of Nuclear Medicine, et al. Cardiovascular nuclear imaging: balancing proven clinical value and potential radiation risk. J Nucl Med. 2011;52:1162–4.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Sabha Bhatti
    • 1
  • Robert C. Hendel
    • 2
  • Juan Lopez-Mattei
    • 3
    • 4
  • Ronald G. Schwartz
    • 5
  • Gilbert Raff
    • 6
  • Andrew J. Einstein
    • 7
    • 8
    Email author
  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Departments of Medicine and RadiologyUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Division of Diagnostic Imaging, Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Division of Internal Medicine, Department of CardiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Cardiology Division, Department of Medicine, Nuclear Medicine Division, Department of Imaging SciencesUniversity of RochesterRochesterUSA
  6. 6.Department of Cardiovascular MedicineWilliam Beaumont HospitalRoyal OakUSA
  7. 7.Department of Medicine, Division of CardiologyColumbia University Medical Center and New York-Presbyterian HospitalNew YorkUSA
  8. 8.Department of RadiologyColumbia University Medical Center and New York-Presbyterian HospitalNew YorkUSA

Personalised recommendations