1. Cardiac function may be compromised in patients with elevated blood cobalt levels secondary to metal-on-metal hip implants.
- Author
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Jenkinson MRJ, Meek DRM, Tate R, Brady A, MacMillan S, Grant H, and Currie S
- Subjects
- Humans, Cobalt adverse effects, Stroke Volume, Ventricular Function, Left, Metals, Chromium adverse effects, Prosthesis Design, Metal-on-Metal Joint Prostheses adverse effects, Arthroplasty, Replacement, Hip Prosthesis adverse effects, Cardiomyopathies, Arthroplasty, Replacement, Hip adverse effects
- Abstract
Aims: Elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties are a suggested risk factor for developing cardiovascular complications including cardiomyopathy. Clinical studies assessing patients with MoM hips using left ventricular ejection fraction (LVEF) have found conflicting evidence of cobalt-induced cardiomyopathy. Global longitudinal strain (GLS) is an echocardiography measurement known to be more sensitive than LVEF when diagnosing early cardiomyopathies. The extent of cardiovascular injury, as measured by GLS, in patients with elevated blood cobalt levels has not previously been examined., Methods: A total of 16 patients with documented blood cobalt ion levels above 13 µg/l (13 ppb, 221 nmol/l) were identified from a regional arthroplasty database. They were matched with eight patients awaiting hip arthroplasty. All patients underwent echocardiography, including GLS, investigating potential signs of cardiomyopathy., Results: Patients with MoM hip arthroplasties had a mean blood cobalt level of 29 µg/l (495 nmol/l) compared to 0.01 µg/l (0.2 nmol/l) in the control group. GLS readings were available for seven of the MoM cohort, and were significantly lower when compared with controls (-15.5% vs -18% (MoM vs control); p = 0.025)). Pearson correlation demonstrated that GLS significantly correlated with blood cobalt level ( r = 0.8521; p < 0.001). However, there were no differences or correlations for other echocardiography measurements, including LVEF (64.3% vs 63.7% (MoM vs control); p = 0.845)., Conclusion: This study supports the hypothesis that patients with elevated blood cobalt levels above 13 µg/l in the presence of a MoM hip implant may have impaired cardiac function compared to a control group of patients awaiting hip arthroplasty. It is the first study to use the more sensitive parameter of GLS to assess for any cardiac contractile dysfunction in patients with a MoM hip implant and a normal LVEF. Larger studies should be performed to determine the potential of GLS as a predictor of cardiac complications in patients with MoM arthroplasties., Competing Interests: S. Currie and M. Jenkinson report that this study was supported by a Heart Research UK project grant (ref RG2675/18/20). R. M. D. Meek reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stryker and Palacdemy, and an annual stipend for a Specialty Editor role on The Bone & Joint Journal, all of which are unrelated to this study., (© 2024 The British Editorial Society of Bone & Joint Surgery.)
- Published
- 2024
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