Anthracyclines remain the cornerstone of the treatment in many cancers including lymphomas, leukemia and sarcomas, and breast cancer. The cardiomyopathy that develops from anthracyclines can lead to heart failure and decreased survival. Multiple mechanisms are involved in the pathophysiology of anthracycline-induced heart failure.
We hypothesize that anthracycline-induced cardiac (AIC) pathology can be monitored using a panel of blood biomarkers including high-sensitive cardiac troponin T (hs-cTnT) for myocyte necrosis and N-terminal prohormone brain natriuretic peptide (NT-proBNP) for parietal stress.
A prospective, institutionally approved study recruited all patients with cancer scheduled to start anthracycline chemotherapy in the Transylvania University cancer clinics.
Transthoracic 2D echocardiography and the measurements of NT-proBNP and hs-cTnT plasma levels were performed at the beginning of the study and 3 months and 6 months after anthracycline treatment initiation.
The plasma levels of hs-cTnT at 3 months (rho = 0.439, P = 0.0001) and 6 months (rho = 0.490, P = 0.0001) are correlated with AIC occurrence. For a cutoff value of hs-cTnT at 3 months > 0.008 ng/mL, we obtained 66.7% sensitivity and 67.9% specificity for developing AIC at 6 months, with a 54.5% positive predictive value and a 87.8% negative predictive value. The NT-proBNP serum levels at 3 months (rho = 0.495, P = 0.0001) and 6 months (rho = 0.638, P = 0.0001) are correlated with an AIC diagnosis at 6 months. For a cutoff value of NT-proBNP at 3 months >118.5 pg/mL, we obtained 80% sensitivity and 79.2% specificity for evolution to AIC at 6 months, with 52.2% positive predictive value and 93.3% negative predictive value.
In anthracycline-treated cancer patients, the increase in plasma levels of NT-proBNP and of hs-cTnT can predict the development of anthracycline-induced cardiomyopathy. Early identification of at-risk patients will potentially allow for targeted dose reductions and will diminish the number of patients developing cardiac pathology.
1Department of Cardiology, Emergency County Clinical Hospital and Transilvania University, School of Medicine, Brasov, Romania;
Departments of Oncology2 and
3Cardiology, Transilvania University, School of Medicine, Brasov, Romania;
4University of Pitesti, Faculty of Sciences, Physical Education and Informatics, Medical Assistance and Physical Therapy Department, Pitesti;
5Department of Bioethics, Transilvania University, School of Medicine, Brasov, Romania;
6Department of Medicine, University of California, Irvine; and
7Neurology, Clinical Research, UC Irvine School of Medicine, Irvine, CA.
Address for correspondence: Professor of Cardiology Lecturer, University of Pitesti, Faculty of Sciences, Physical Education and Informatics, Medical Assistance and Physical Therapy Department, Targu din Vale Street, No. 1, Pitesti 110040, Arges, Romania. E-mail: firstname.lastname@example.org
The authors have no conflicts of interest to declare.