Table I.
A summary of cases reporting cobalt-induced cardiomyopathy. The normal recorded values for left ventricular ejection fraction were 55% to 70%.
| Cardiac presentation | Implant | Sample | Cobalt (µg/l) | Length of follow-up | Echocardiogram results | Outcome |
|---|---|---|---|---|---|---|
| Dyspnoea, neurotoxicity39-41 | Primary MoM arthroplasty | Serum | 122 | 18 months | Diastolic dysfunction | Revision, symptoms resolved |
| Dyspnoea39-41 | Revision MoM arthroplasty | Serum | 23 | 43 months | N/A | Revision, symptoms resolved |
| Dyspnoea, chest pain42 | Primary MoM arthroplasty | Serum | 13 | 6 years | Dilated atrium, decreased LVEF (21%) | Revision, LVEF (45%) |
| Exertional dyspnoea, cough43 | Primary bilateral MoM resurfacings | Serum | 287 | 4 years | Decreased LVEF (10%) | Heart transplant, hip revision |
| Cardiomyopathy62 | Failed CoC revised to MoM | Serum | 506 | N/A | Left ventricular hypertrophy | Chelation therapy, revision, symptoms improved |
| Dyspnoea44 | Primary MoM resurfacing | Serum | 258 | 3 years | N/A | Revision surgery, symptoms resolved |
| Exertional chest tightness, fatigue45 | Primary bilateral MoM arthroplasties | Whole blood | 189 | 11 months | Decreased LVEF (30%) | Heart transplant, bilateral hip revisions |
| Dyspnoea46 | Primary bilateral MoM arthroplasties | Did not specify | 200 to 300 | 2 years | Decreased LVEF (10% to 15%) | Death |
| Fatigue52 | Failed CoC revised to MoP | Whole blood | 6,521 | 6 months | Pericardial effusion | Death |
| Dyspnoea, fatigue53 | Failed CoC revised to MoP | Serum | 489 | 6 years | Left ventricular hypertrophy, pericardial effusion, decreased LVEF (13%) | Chelation, revision normal LVEF (58%). |
| Dyspnoea, orthopnea53 | Failed CoC revised to MoP | Serum | 112 | 6 years | Decreased LVEF (24%), pericardial effusion | Revision surgery, chelation, heart transplantation |
| Cardiogenic shock54 | Failed CoC revised to MoP | Serum | 652 | N/A | N/A | Heart transplant |
| Cardiomyopathy56 | Failed CoP revised to MoP | Serum | 625 | 2 months | Left ventricular hypertrophy | Revision surgery, symptoms resolved |
| Dyspnoea55 | Failed CoC revised to MoP | Whole blood | 641 | 10 months | LVEF 15% to 20% | Death |
| Dyspnoea, orthopnoea47 | MoM | Whole blood | 246 | 4 years | Diastolic dysfunction, decreased LVEF (20%) | Revision surgery, symptoms resolved, LVEF 45% to 50% |
| Heart failure48 | MoM | Serum | 169 | 10 years | N/A | Heart transplantation, revision surgery |
| Exertional dyspnoea49 | Bilateral MoM | Did not specify | 156 | 2 years | Dilated cardiomyopathy with decreased LVEF (20%) | LVAD inserted, no improvement, bilateral hip revisions 1 year later, symptoms resolved |
| Heart failure50 | Bilateral MoM | Serum | 120 | N/A | Decreased LVEF (36%) | Bilateral revision surgery, LVAD |
| Heart failure51 | MoM | Serum | 200 to 300 | N/A | Decreased LVEF (14%) | Death |
| Heart failure57 | Failed CoC revised to MoP | Whole blood | 780 | 2 years | Decreased LVEF (25%) | Chelation therapy, revision surgery, LVEF 40% |
| Dyspnoea, chest tightness58 | Failed CoC revised to MoP | N/A | 45 | 8 years | Dilated cardiomyopathy, reduced LVEF (28%) | Revision surgery, symptoms resolved |
| Dyspnoea, fatigue59 | Failed CoC revised to MoP | Serum | 373 | 3 years | Dilated cardiomyopathy, severe left ventricular dysfunction, LVEF (20%) | Death |
| Fatigue, tachycardia60 | Failed CoC revised to MoP | Did not specify | 788 | 8 years | N/A | Revision surgery, symptoms resolved |
| Dyspnoea61 | Failed CoC revised to MoP | Did not specify | 397 | N/A | Decreased LVEF (25%) | Chelation therapy, revision surgery, symptoms resolved |
CoC, ceramic-on-ceramic; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; MoM, metal-on-metal; MoP, metal-on-polyethylene; N/A, not available.