Late Anthracycline Cardiotoxicity Mimicking Arrhythmogenic Cardiomyopathy in a Young Adult

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-09-11 DOI:10.1016/j.jaccas.2026.110273

Maroun Chedid MD, Collin Barrett MD, Melanie Sun MS, Andrew Lesser MD, Katarxyna Hryniewicz MD

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Abstract

Background

Doxorubicin-induced cardiotoxicity can manifest years after exposure and may mimic other cardiomyopathies in young patients, making the diagnosis of delayed doxorubicin cardiotoxicity challenging in these patients.

Case Summary

A 26-year-old physically active man with childhood Burkitt’s lymphoma treated with doxorubicin (120 mg/m² cumulative) presented with exertional chest discomfort and palpitations. Resting electrocardiogram and ambulatory monitoring were unremarkable. Transthoracic echocardiography demonstrated preserved ejection fraction (55%-60%) but reduced global longitudinal strain (−15%). Cardiac magnetic resonance revealed low-normal biventricular function with nonischemic septal late gadolinium enhancement and reduced strain. Exercise stress testing demonstrated impaired contractile reserve, septal mechanical dyssynchrony, and exercise-induced QRS prolongation. Coronary computed tomography angiography excluded coronary artery disease.

Discussion

This case highlights that anthracycline cardiotoxicity may present late, mimic myocardial ischemia, arrhythmogenic cardiomyopathy, and other cardiomyopathies.

Take-Home Message

A high index of suspicion is required for late cardiotoxicity in young cancer survivors.

查看原文本刊更多论文

青壮年晚期蒽环类药物心脏毒性模拟心律失常性心肌病。

背景：阿霉素诱导的心脏毒性可在暴露多年后显现，并可能模仿年轻患者的其他心肌病，这使得这些患者的延迟性阿霉素心脏毒性的诊断具有挑战性。病例总结：一名26岁的运动男性儿童伯基特淋巴瘤患者接受阿霉素（累积120 mg/m2）治疗，表现为运动性胸部不适和心悸。静息心电图和动态监测无显著差异。经胸超声心动图显示射血分数保留（55%-60%），但整体纵向应变降低（-15%）。心脏磁共振显示双心室功能低正常，非缺血性间隔晚期钆增强和应变降低。运动应激测试显示收缩储备受损、室间隔机械不同步和运动诱导的QRS延长。冠状动脉ct血管造影排除冠状动脉疾病。讨论：本病例强调了蒽环类药物的心脏毒性可能出现较晚、类似心肌缺血、心律失常性心肌病和其他心肌病。关键信息：年轻癌症幸存者的晚期心脏毒性需要高度的怀疑指数。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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