Elevated levels of circulating cobalt ions have been linked with a wide range of systemic complications including neurological, endocrine, and cardiovascular symptoms. Case reports of patients with elevated blood cobalt ions have described significant cardiovascular complications including cardiomyopathy. However, correlation between the actual level of circulating cobalt and extent of cardiovascular injury has not previously been performed. This review examines evidence from the literature for a link between elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties and cardiomyopathy. Correlation between low, moderate, and high blood cobalt with cardiovascular complications has been considered. Elevated blood cobalt at levels over 250 µg/l have been shown to be a risk factor for developing systemic complications and published case reports document cardiomyopathy, cardiac transplantation, and death in patients with severely elevated blood cobalt ions. However, it is not clear that there is a hard cut-off value and cardiac dysfunction may occur at lower levels. Clinical and laboratory research has found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. Further work needs to be done to clarify the link between severely elevated blood cobalt ions and cardiomyopathy. Cite this article: Bone Joint Res 2021;10(6):340-347.

中文翻译：

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钴诱发的心肌病——循环中的钴水平重要吗？

循环钴离子水平升高与多种全身并发症有关，包括神经系统、内分泌和心血管症状。血液钴离子升高患者的病例报告描述了严重的心血管并发症，包括心肌病。然而，循环钴的实际水平与心血管损伤程度之间的相关性以前没有进行过。本综述审查了文献中关于继发于金属对金属 (MoM) 髋关节置换术和心肌病的血液钴水平升高之间存在联系的证据。已经考虑了低、中和高血钴与心血管并发症之间的相关性。血液钴浓度超过 250 µg/l 已被证明是发生全身并发症的危险因素，已发表的病例报告记录了血液钴离子严重升高的患者的心肌病、心脏移植和死亡。然而，目前尚不清楚是否存在硬临界值，在较低水平时可能会出现心功能不全。临床和实验室研究发现了 MoM 髋关节患者钴诱发心肌病的相互矛盾的证据。需要做进一步的工作来澄清严重升高的血液钴离子与心肌病之间的联系。引用这篇文章：目前尚不清楚是否存在硬临界值，在较低水平时可能会出现心功能不全。临床和实验室研究发现了 MoM 髋关节患者钴诱发心肌病的相互矛盾的证据。需要做进一步的工作来澄清严重升高的血液钴离子与心肌病之间的联系。引用这篇文章：目前尚不清楚是否存在硬临界值，在较低水平时可能会出现心功能不全。临床和实验室研究发现了 MoM 髋关节患者钴诱发心肌病的相互矛盾的证据。需要做进一步的工作来澄清严重升高的血液钴离子与心肌病之间的联系。引用这篇文章：骨关节研究 2021；10(6):340-347。