Biomarkers for the detection of apparent and subclinical cancer therapy-related cardiotoxicity

Michel, Lars; Rassaf, Tienush; Totzeck, Matthias

doi:10.21037/jtd.2018.08.15

Cited by 82 publications

(76 citation statements)

References 122 publications

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“…Large studies investigating cardiac troponin as marker for cardiotoxicity in adult patients have shown robust data on troponin as a predictor of chemotherapy‐related cardiotoxicity . It is hypothesized that troponin indicates early myocardial injury in response to anthracycline exposure and thereby predicts development of manifest heart failure in the further course.…”

Section: Discussionmentioning

confidence: 99%

“…Both biomarkers were identified as potential markers for chemotherapy‐related LV dysfunction and concomitant manifest heart failure in adult cancer patients. They are recommended as an auxiliary measure for diagnosis and monitoring by the European and American cardio‐oncology position papers . Cardiac biomarkers also have the potential to identify childhood cancer patients who are likely to have cancer therapy‐related LV dysfunction and require further workup including echocardiography, but systematic evidence is sparse …”

Section: Introductionmentioning

confidence: 99%

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Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

et al. 2020

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Aims Childhood cancer therapy is associated with a significant risk of therapy-related cardiotoxicity. This meta-analysis aims to evaluate cardiac biomarkers for the detection of cancer therapy-related left ventricular (LV) dysfunction in childhood cancer patients. Methods and results PubMed, Cochrane Library, Wiley Library, and Web of Science were screened for studies investigating brain natriuretic peptide (BNP)/N-terminal proBNP (NT-proBNP) or cardiac troponin in childhood cancer patients. The odds ratios (OR) for elevation of cardiac biomarkers and association with LV dysfunction were calculated using a random-effects model. Data from 27 studies with 1651 subjects were included. BNP/NT-proBNP levels were higher post-treatment compared with controls or pre-treatment values [standardized mean difference = 1.0; 95% confidence interval (CI) = 0.6-1.4; n = 320; P < 0.001]. LV dysfunction was present in 11.76% of included patients, and risk for LV dysfunction was increased in patients with elevated BNP/NT-proBNP (OR = 7.1; 95% CI = 2.0-25.5; n = 350; P = 0.003). The sensitivity of BNP/NT-proBNP for the detection of LV dysfunction was 33.3%, and the specificity was 91.5%. Sensitivity increased when selecting for studies that assessed patients < 5 years after anthracycline exposure and for studies including high cumulative anthracycline doses. Anthracycline chemotherapy was associated with an increased frequency of elevated troponin (OR = 3.7; 95% CI = 2.1-6.5; n = 348; P < 0.001). The available evidence on the association between elevated troponin and LV dysfunction was insufficient for an adequate analysis. In five included studies, the frequency of LV dysfunction was not increased in patients with elevated troponin (OR = 2.5; 95% CI = 0.5-13.2; n = 179; P = 0.53). Conclusions BNP/NT-proBNP is associated with cardiotoxicity in paediatric cancer patients receiving anthracycline therapy, but owing to low sensitivity, BNP/NT-proBNP has to be evaluated in the context of further parameters including clinical assessment and echocardiography. Future studies are needed to determine whether troponin serves as a marker for cardiotoxicity in children. Standardized recommendations for the application of cardiac biomarkers in children undergoing cardiotoxic cancer therapy may benefit management and clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

et al. 2020

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“…Finally, fluid overload, anaemia, kidney disease or sepsis are common cancer-associated co-morbidities that may have had confounding influences on cardiac biomarkers. 2,17…”

Section: Limitationsmentioning

confidence: 99%

“…However, this may also take weeks to become significant and early detection of cancer therapy‐related cardiotoxicity is critical for the timely initiation of protective therapy with β‐blockers and/or angiotensin‐converting enzyme (ACE) inhibitors . Cardiac biomarkers with a high negative predictive value can be suitable for screening and have been studied in various settings in patients at risk for cancer therapy‐related cardiotoxicity . In smaller cohorts, assessment of cardiac troponins has been related to cancer therapy‐related cardiotoxicity when assessed as early as 72 h after chemotherapy .…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Cardiac biomarkers with a high negative predictive value can be suitable for screening and have been studied in various settings in patients at risk for cancer therapy-related cardiotoxicity. 17 In smaller cohorts, assessment of cardiac troponins has been related to cancer therapy-related cardiotoxicity when assessed as early as 72 h after chemotherapy. 18 Prolonged troponin elevation predicted higher rates of cardiotoxicity.…”

Section: Introductionmentioning

confidence: 99%

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Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis

Michel

Mincu

Mahabadi

et al. 2019

European J of Heart Fail

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Aims Cardiac biomarkers are a mainstay in diagnosis of cardiovascular disease but their role in cardio‐oncology has not yet been systematically evaluated. This meta‐analysis aims to determine whether cardiac troponins and (N‐terminal pro) brain natriuretic peptide (BNP/NT‐proBNP) predict cancer therapy‐related left ventricular (LV) dysfunction. Methods and results Scientific databases were searched for studies that assessed troponins or BNP/NT‐proBNP in adult patients undergoing cancer therapy. Data from 61 trials with 5691 patients were included. Cancer therapy was associated with an increase in troponin levels [odds ratio (OR) 14.3, 95% confidence interval (CI) 6.0–34.1; n = 3049]. Patients with elevated troponins receiving chemotherapy or human epidermal growth factor receptor 2 inhibitor therapy were at higher risk for LV dysfunction (OR 11.9, 95% CI 4.4–32.1; n = 2163). Troponin had a negative predictive value of 93%. Mean BNP/NT‐proBNP levels were increased in patients post‐treatment (standardized mean difference 0.6, 95% CI 0.3–0.9; n = 912), but the available evidence did not consistently indicate prediction of LV dysfunction (OR 1.7, 95% CI 0.7–4.2; n = 197). β‐blocker and angiotensin‐converting enzyme inhibitor therapy to mitigate cardiotoxicity during cancer therapy was associated with a decline in serum troponins (OR 4.1, 95% CI 1.7–9.8; n = 466). Conclusion Elevated troponin levels predict LV dysfunction in patients receiving cancer therapy. Assessment of troponin levels may qualify as a screening test to identify patients who require referral to cardio‐oncology units and benefit from preventive strategies. Further evidence is required for both biomarkers.

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Early identification of severe immune checkpoint inhibitor associated myocarditis: From an electrocardiographic perspective

Gao,

Zhang,

Qiu

et al. 2024

Cancer Medicine

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ObjectivesImmune checkpoint inhibitor (ICI)‐associated myocarditis, particularly severe ICI‐associated myocarditis, has a high mortality rate. However, the predictive value of electrocardiogram (ECG) remains unclear. The present study aimed to evaluate the predictive value of clinical and electrocardiographic parameters for severe myocarditis.MethodsClinical and electrocardiographic data of 73 cancer patients with ICI‐associated myocarditis were retrospectively collected. The severity of ICI‐associated myocarditis was graded using the NCCN guidelines for managing immunotherapy‐related toxicities. Myocarditis grades 1–2 and grades 3–4 were classified as mild and severe myocarditis, respectively. Logistic regression analysis was performed to analyze the predictive value of each parameter in predicting severe myocarditis.ResultsAmong the 73 patients with myocarditis, 20 (27.4%) patients had severe myocarditis. Compared with mild myocarditis group, sinus tachycardia (p = 0.001), QRS duration ≥110 ms (p = 0.001), prolonged QTc interval (p < 0.001), and bundle branch block (p = 0.007) at the time of myocarditis were more common in the severe myocarditis group. Logistic regression analysis revealed that sinus tachycardia (p = 0.028) and QTc interval prolongation (p = 0.007) were predictors of severe myocarditis. Whereas the predictive value of other electrocardiographic parameters was weak. Concurrent targeted therapy didn't increase the risk of severe myocarditis. A high NT‐proBNP level was associated with severe myocarditis.ConclusionsECG at the onset of myocarditis manifested as sinus tachycardia and prolonged QTc interval predicted a high risk of severe myocarditis. Early detection of ECG abnormalities may faciliate early detection of severe ICI‐associated myocarditis.

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Biomarkers for the detection of apparent and subclinical cancer therapy-related cardiotoxicity

Cited by 82 publications

References 122 publications

Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis

Early identification of severe immune checkpoint inhibitor associated myocarditis: From an electrocardiographic perspective

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