Direct Left Ventricular Metastasis Reduction: 3D-Echo Monitoring For Management of Clinical Case

A 52-year-old woman with a lung carcinoma metastatic to bone was admitted to the Cardiology Department for acute chestpain after 1 week of the oncologic therapy. Electrocardiographic examination (ECG) revealed ischemic picture with ST-T waveabnormalities in DI and aVL leads and poor progression of R wave in V1-V4 leads. Two- and three-dimensional transthoracicechocardiography (2D/3D TTE) showed myocardial involvement with infiltration of the anterolateral left ventricular (LV) wall fromthe epicardial to the endocardial layer, apical hypokinesia, LV ejection fraction (LVEF) and global 3D longitudinal strain reduction,but was absent pericardial effusion. Three months from the beginning of erlotinib, the patient showed a significant reduction inmyocardial involvement with no ECG-ST elevation. Echo showed a mild regression of the wall infiltration and a slightly improvementof LVEF and strain. A computed tomography (CT) scan showed partial remission of the primary lung lesion, intracavitary andintramyocardial mass.