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ONCOLOGY, NUCLEAR MEDICINE AND TRANSPLANTOLOGY
Original Article
Aug 05, 2026 2 2

Multidisciplinary Management of Gastric GIST in a Patient with Severe Ischemic Cardiomyopathy Requiring Implantable Cardioverter-Defibrillator: A Case Report

Zhandos Burkitbayev 1,
Azat Chinaliev 2,
Zarina Ryskulova 3 * ,
Mansur Kassymov 4,
Dauletbek Marat 5,
Sanzhana Alimkulova 6
1 Chairman of the Management Board, National Research Oncology center, Astana, Kazakhstan2 Department of Expert Endoscopy and Interventional Radiology, National Research Oncology Center, Astana, Kazakhstan3 Department of expert endoscopy and interventional radiology, National Research Oncology Center, Astana, Kazakhstan4 Angiosurgeon, Department of Expert Endoscopy and Interventional Radiology, National Research Oncology Center, Astana, Kazakhstan5 Multidisciplinary therapy and rehabilitation center, National Research Oncology Center, Astana, Kazakhstan6 Resident Cardiologist, Astana Medical University, Astana, Kazakhstan* Corresponding Author
Oncology, Nuclear Medicine and Transplantology, 2(3), 2026, onmt025, https://doi.org/10.63946/onmt/19079
Publication date: Aug 05, 2026
Full Text (PDF)

ABSTRACT

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. Their surgical management can be complicated by severe comorbidities, particularly advanced cardiovascular disease. We report a case of gastric GIST in a patient with ischemic cardiomyopathy, recurrent coronary interventions, and reduced ejection fraction, requiring implantable cardioverter-defibrillator (ICD) placement prior to tumor resection.
Case presentation: A 67-year-old man with a history of myocardial infarction, coronary artery bypass grafting, multiple percutaneous coronary interventions, and chronic heart failure presented with dyspnea, chest discomfort, and fatigue. During evaluation, an ulcerated gastric mass (cT3N0) consistent with GIST was identified. Echocardiography revealed an ejection fraction of 35–37% with apical aneurysm. Holter monitoring showed marked bradyarrhythmia and atrioventricular block. Given the high anesthetic risk, a multidisciplinary tumor board recommended initial cardiac optimization. The patient underwent implantation of a dual-chamber ICD (Biotronik Rivacor 5 MRI DR) and was stabilized with guideline-directed medical therapy and intermittent levosimendan infusion.
Outcome: Following optimization, the patient’s clinical status improved, with ejection fraction increasing to 37% and resting heart rate stabilized around 56 bpm. He subsequently underwent partial gastrectomy with duodenal anastomosis. Histology confirmed a low-risk GIST (M8936/3, <5 mitoses/50 HPF). The postoperative period was uneventful.
Conclusion: This case highlights the importance of a multidisciplinary, staged approach in managing oncological patients with advanced cardiovascular disease. Preoperative ICD implantation and optimization of heart failure therapy enabled safe surgical resection of gastric GIST.

KEYWORDS

Gastrointestinal Stromal Tumor Ischemic Cardiomyopathy Implantable Cardioverter-Defibrillator Multidisciplinary Management Cardiac Optimization

CITATION (Vancouver)

Burkitbayev Z, Chinaliev A, Ryskulova Z, Kassymov M, Marat D, Alimkulova S. Multidisciplinary Management of Gastric GIST in a Patient with Severe Ischemic Cardiomyopathy Requiring Implantable Cardioverter-Defibrillator: A Case Report. Oncology, Nuclear Medicine and Transplantology. 2026;2(3):onmt025. https://doi.org/10.63946/onmt/19079
APA
Burkitbayev, Z., Chinaliev, A., Ryskulova, Z., Kassymov, M., Marat, D., & Alimkulova, S. (2026). Multidisciplinary Management of Gastric GIST in a Patient with Severe Ischemic Cardiomyopathy Requiring Implantable Cardioverter-Defibrillator: A Case Report. Oncology, Nuclear Medicine and Transplantology, 2(3), onmt025. https://doi.org/10.63946/onmt/19079
Harvard
Burkitbayev, Z., Chinaliev, A., Ryskulova, Z., Kassymov, M., Marat, D., and Alimkulova, S. (2026). Multidisciplinary Management of Gastric GIST in a Patient with Severe Ischemic Cardiomyopathy Requiring Implantable Cardioverter-Defibrillator: A Case Report. Oncology, Nuclear Medicine and Transplantology, 2(3), onmt025. https://doi.org/10.63946/onmt/19079
AMA
Burkitbayev Z, Chinaliev A, Ryskulova Z, Kassymov M, Marat D, Alimkulova S. Multidisciplinary Management of Gastric GIST in a Patient with Severe Ischemic Cardiomyopathy Requiring Implantable Cardioverter-Defibrillator: A Case Report. Oncology, Nuclear Medicine and Transplantology. 2026;2(3), onmt025. https://doi.org/10.63946/onmt/19079
Chicago
Burkitbayev, Zhandos, Azat Chinaliev, Zarina Ryskulova, Mansur Kassymov, Dauletbek Marat, and Sanzhana Alimkulova. "Multidisciplinary Management of Gastric GIST in a Patient with Severe Ischemic Cardiomyopathy Requiring Implantable Cardioverter-Defibrillator: A Case Report". Oncology, Nuclear Medicine and Transplantology 2026 2 no. 3 (2026): onmt025. https://doi.org/10.63946/onmt/19079
MLA
Burkitbayev, Zhandos et al. "Multidisciplinary Management of Gastric GIST in a Patient with Severe Ischemic Cardiomyopathy Requiring Implantable Cardioverter-Defibrillator: A Case Report". Oncology, Nuclear Medicine and Transplantology, vol. 2, no. 3, 2026, onmt025. https://doi.org/10.63946/onmt/19079

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