Bortezomib induced reversible left ventricular systolic dysfunction: A case report and review of literature

Bortezomib is a reversible proteasome inhibitor, currently approved by US FDA for use in multiple myeloma and mantle cell lymphoma. Bortezomib has been shown to cause new onset and exacerbation of underlying congestive cardiac failure (CHF) in some case reports. Studies on human tissue have shown dysregulation of ubiquitin proteasome system (UPS) in cardiac tissues in end stage heart failure. Recently, an animal study has shown reduced left ventricular contractility after bortezomib administration, which was attributed to reduced ATP synthesis in mitochondria of cardiac myocytes. Our case demonstrates development of new onset severe reversible left ventricular systolic dysfunction after 4 cycles of bortezomib in a 58 year old female with multiple myeloma. Her only medical condition was well controlled hypertension and she did not have any other risk factor for coronary artery disease. We also present a review of all case reports of CHF associated with bortezomib administration published till date and occurrence of CHF with bortezomib administration in major clinical trials of multiple myeloma. Our manuscript highlights the importance of maintaining a high level of suspicion for development of CHF after therapy with bortezomib. Currently, there is no guideline for routine evaluation and monitoring of cardiac function in all patients during the course of bortezomib therapy. Further studies are required in future to address this issue.