title: Antifungal-Associated Drug-Induced Cardiac Disease.
abstract: The etiology of cardiomyopathies are classified into 4 main groupings (dilated, hypertrophic, restrictive, and idiopathic) and can be mechanistically caused by myocarditis, conduction abnormalities, focal direct injury, or nutritional deficiency. Based on our review of this topic, evidence suggests that echinocandin-related cardiac dysfunction is a mitochondrial drug-induced disease caused by focal direct myocyte injury. With caspofungin or anidulafungin administration into the heart via central line, exposure is likely extreme enough to induce the acute toxicity. Chronic or low-dose exposure may lead to hypertrophic cardiomyopathy; however, only acute exposures have been explored to date.
authors.affiliation: School of Medicine School of Pharmacy, University of Mississippi School of St Dominic-Jackson Memorial Hospital, Mississippi.
authors.forename: John D
authors.initials: JD
authors.lastname: Cleary
authors.affiliation: School of Pharmacy, University of Mississippi.
authors.forename: Kayla R
authors.initials: KR
authors.lastname: Stover
mesh_terms: D000077612:Anidulafungin; D000818:Animals; D000935:Antifungal Agents / Q000009:adverse effects* / Q000737:chemistry / Q000633:toxicity; D002302:Cardiac Output / Q000187:drug effects; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D002311:Cardiomyopathy, Dilated / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D066126:Cardiotoxicity / Q000209:etiology; D000077336:Caspofungin; D054714:Echinocandins / Q000009:adverse effects* / Q000737:chemistry / Q000633:toxicity; D004452:Echocardiography; D006801:Humans; D055666:Lipopeptides; D008929:Mitochondria, Heart / Q000187:drug effects* / Q000378:metabolism / Q000648:ultrastructure
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077612:Anidulafungin; D000077336:Caspofungin
keywords: cardiac output; cardiac toxicity; echinocandin; echocardiography