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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?
Methods:
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.
Results:
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.
Conclusions:
The authors concluded that cardiac troponin plasma concentrations and longitudinal strain predict the development of cardiotoxicity in patients treated with anthracyclines and trastuzumab.
Perspective:
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.
Keywords: Antibodies, Monoclonal, Humanized, Biomarkers, Heart Failure, Anthracyclines, Troponin, Echocardiography
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