Early Detection and Prediction of Cardiotoxicity in Chemotherapy-Treated Patients

Study Questions:

What is the predictive ability of more sensitive echocardiographic measurements and biomarkers on future cardiac dysfunction in chemotherapy-treated patients?


Forty-three patients diagnosed with breast cancer who received anthracyclines and trastuzumab therapy underwent echocardiography and blood sampling at three time points (baseline and 3 and 6 months during the course of chemotherapy). The left ventricular ejection fraction (LVEF); peak systolic myocardial longitudinal, radial, and circumferential strain; echocardiographic markers of diastolic function; N-terminal pro–B-type natriuretic peptide (NT-proBNP); and high-sensitivity cardiac troponin I were measured. Possible predictors of cardiotoxicity were tested using univariate nominal logistic regression. A multiple nominal logistic regression model including longitudinal strain and troponin levels at 3 months was then applied to the univariate predictors.


Nine patients (21%) developed cardiotoxicity (1 at 3 months and 8 at 6 months), as defined by the Cardiac Review and Evaluation Committee reviewing trastuzumab. A decrease in longitudinal strain from baseline to 3 months and detectable high-sensitivity cardiac troponin I at 3 months were independent predictors of the development of cardiotoxicity at 6 months. The LVEF, parameters of diastolic function, and NT-proBNP did not predict cardiotoxicity.


The authors concluded that cardiac troponin plasma concentrations and longitudinal strain predict the development of cardiotoxicity in patients treated with anthracyclines and trastuzumab.


The study suggests that in patients treated with a combination of anthracyclines and trastuzumab, an early decrease in myocardial strain or elevation in plasma troponin as detected with a high-sensitivity assay predicts the later occurrence of cardiotoxicity. Subsequent cardiotoxicity does not appear to be predicted by early changes in the LVEF or NT-proBNP level. Myocardial strain and high-sensitivity cardiac troponin I measurements may, therefore, help target patients who could benefit from closer cardiac monitoring, earlier initiation of cardioprotective medical therapy, or less cardiotoxic novel anticancer drugs.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Novel Agents, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound

Keywords: Antibodies, Monoclonal, Humanized, Biological Markers, Heart Failure, Anthracyclines, Troponin, Echocardiography

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