{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:57:45Z","timestamp":1770058665013,"version":"3.49.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background\u2003<\/jats:title>\n                  <jats:p>The first series of cobalt cardiomyopathy was described in the 60s in relation to the abuse of a cobalt containing beer. Since then, millions of metal hip arthroplasties have been performed and a small number of cobalt cardiomyopathies related to metal prosthesis have been reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary\u2003<\/jats:title>\n                  <jats:p>We report a case of a 48-year-old man who developed a severe non-dilated restrictive cardiomyopathy in the setting of a systemic metallosis following several hip arthroplasties. The diagnosis was suspected by exclusion of other more common causes for restrictive cardiomyopathies and confirmed by the levels of cobalt and chromium in the serum and the endomyocardial biopsy performance that showed metal deposits in myocardial tissue. Despite the removal of the metal prosthesis and a significant decrease in serum metal levels, he suffered cardiogenic shock (CS) and electric storm that required emergency mechanical circulatory support as a bridge to heart transplant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion\u2003<\/jats:title>\n                  <jats:p>Cobalt cardiomyopathy is a rare condition that has been observed in patients who develop cobalt toxicity after metal hip arthroplasty. The condition may improve after diagnosis and removal of the prosthesis or get worse and progress to end-stage heart failure or CS. The concern about the metal toxicity associated with metal hip prosthesis has increased in the last few years. Orthopaedic surgeons and cardiologists should be aware of this severe complication that is probably under diagnosed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab057","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T19:37:53Z","timestamp":1617737873000},"source":"Crossref","is-referenced-by-count":5,"title":["A case report of cobalt cardiomyopathy leading to electric storm and cardiogenic shock: the importance of the orthopaedic background in patients with heart failure of unknown aetiology"],"prefix":"10.1093","volume":"5","author":[{"given":"Cristina","family":"Castrillo Bustamante","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Marqu\u00e9s de Valdecilla , Avenida Valdecilla 25, Santander 39008, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1ngela","family":"Canteli \u00c1lvarez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Marqu\u00e9s de Valdecilla , Avenida Valdecilla 25, Santander 39008, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"Burgos Palacios","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Marqu\u00e9s de Valdecilla , Avenida Valdecilla 25, Santander 39008, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Aurelio","family":"Sarralde Aguayo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hospital Universitario Marqu\u00e9s de Valdecilla , Avenida Valdecilla 25, Santander 39008, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Serrano Lozano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Marqu\u00e9s de Valdecilla , Avenida Valdecilla 25, Santander 39008, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xabier","family":"Arana Achaga","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Donostia , Paseo Dr Begiristain 107, Donostia 20014, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1lvaro","family":"Nu\u00f1ez Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Donostia , Paseo Dr Begiristain 107, Donostia 20014, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Cobo Belaustegui","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Marqu\u00e9s de Valdecilla , Avenida Valdecilla 25, Santander 39008, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,4,5]]},"reference":[{"key":"2022081605383079100_ytab057-B1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.artd.2019.04.010","article-title":"Cobalt cardiomyopathy in hip arthroplasty","volume":"5","author":"Umar","year":"2019","journal-title":"Arthroplast Today"},{"key":"2022081605383079100_ytab057-B2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.artd.2015.10.002","article-title":"Cardiac cobaltism: a rare complication after bilateral metal-on-metal total hip arthroplasty","volume":"1","author":"Martin","year":"2015","journal-title":"Arthroplast Today"},{"key":"2022081605383079100_ytab057-B3","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1080\/15563650.2016.1214274","article-title":"Fatal cobalt toxicity after total hip arthroplasty revision for fractured ceramic 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Missing elements of the history","volume":"370","author":"Allen","year":"2014","journal-title":"N Engl J Med"},{"key":"2022081605383079100_ytab057-B11","author":"Medicines and Healthcare products Regulatory Agency","year":"2020"},{"key":"2022081605383079100_ytab057-B12","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.artd.2016.11.005","article-title":"Arthroprosthetic cobaltism associated with cardiomyopathy","volume":"3","author":"Charette","year":"2017","journal-title":"Arthroplast Today"},{"key":"2022081605383079100_ytab057-B13","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2106\/JBJS.M.00160","article-title":"Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society","volume":"96","author":"Kwon","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"2022081605383079100_ytab057-B14","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1016\/j.arth.2016.12.050","article-title":"Revision total hip arthroplasty for fractured ceramic bearings: a review of best practices for revision cases","volume":"32","author":"Rambani","year":"2017","journal-title":"J Arthroplast"},{"key":"2022081605383079100_ytab057-B15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/8682737","article-title":"N-acetyl-cysteine as effective and safe chelating agent in metal-on-metal hip-implanted patients: two cases","volume":"2016","author":"Giampreti","year":"2016","journal-title":"Case Rep Orthop"},{"key":"2022081605383079100_ytab057-B16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/5434571","article-title":"Cobalt cardiomyopathy secondary to hip arthroplasty: an increasingly prevalent problem","volume":"2017","author":"Tilney","year":"2017","journal-title":"Case Rep Cardiol"},{"key":"2022081605383079100_ytab057-B17","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.freeradbiomed.2013.06.028","article-title":"Role of direct reactivity with metals in chemoprotection by N-acetylcysteine against chromium (VI), cadmium (II), and cobalt (II)","volume":"65","author":"Luczak","year":"2013","journal-title":"Free Radic Biol Med"},{"key":"2022081605383079100_ytab057-B18","doi-asserted-by":"crossref","first-page":"NP1","DOI":"10.1177\/1120700019834793","article-title":"Heart transplant secondary to cobalt toxicity alter hip arthroplasty revision","volume":"29","author":"Sanz","year":"2019","journal-title":"Hip Int"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/4\/ytab057\/45434206\/ytab057.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/4\/ytab057\/45434206\/ytab057.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T05:39:43Z","timestamp":1660628383000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytab057\/6210420"}},"subtitle":[],"editor":[{"given":"Brian","family":"Halliday","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Domenico","family":"D'Amario","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Constantinos","family":"Bakogiannis","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Rahul","family":"Mukherjee","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Vassilios Parisis","family":"Memtsas","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,1]]},"references-count":18,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4,5]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytab057","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4,1]]},"published":{"date-parts":[[2021,4,1]]},"article-number":"ytab057"}}