title: Cardiac toxicity of the echinocandins: chance or cause and effect association?
abstract: OBJECTIVE
  Fungal infections pose a constant risk to critically ill and immunosuppressed patients. The echinocandin antifungals give practitioners an arsenal of agents with apparently lower toxicity relative to older agents. The objective of this commentary is to review the cardiac toxicity of the echinocandin antifungals in the light of recent evidence and published case reports.
  
  
  CONCLUSIONS
  Three case reports detail cardiac decompensation following the initiation of anidulafungin and caspofungin and corroborate ex vivo laboratory results, in which rat hearts exposed to anidulafungin and caspofungin had significantly decreased cardiac contractility. Our hypothesized mechanism of toxicity of anidulafungin and caspofungin is mitochondrial toxicity.
  
  
  CONCLUSIONS
  The clinical corroboration of the ex vivo work presented above highly suggests that the cardiac toxicity seen with some of the echinocandin antifungals is a cause and effect pattern, not a chance finding.
authors.affiliation: Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA; Division of Infectious Diseases, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: K R
authors.initials: KR
authors.lastname: Stover
authors.forename: S T
authors.initials: ST
authors.lastname: King
authors.forename: J D
authors.initials: JD
authors.lastname: Cleary
mesh_terms: D000077612:Anidulafungin; D000818:Animals; D000935:Antifungal Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000633:toxicity; D000077336:Caspofungin; D054714:Echinocandins / Q000009:adverse effects* / Q000494:pharmacology / Q000633:toxicity; D006321:Heart / Q000187:drug effects*; D006801:Humans; D055666:Lipopeptides
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077612:Anidulafungin; D000077336:Caspofungin
keywords: cardiotoxicity; echinocandins