Change in cardiac troponin T level after intravitreal anti-vascular endothelial growth factor treatment: Prospective pilot study

Abstract

Background: Evaluate subclinical myocardial injury associated with intravitreal anti-vascular endothelial growth factor therapy by measuring serum high-sensitivity cardiac troponin T. Methods: This is a prospective pilot comparative study conducted at American University of Beirut Medical Center, Beirut, Lebanon. In total, 40 consecutive patients were randomized to receive either intravitreal bevacizumab or ranibizumab. Patients received three consecutive monthly injections of the assigned drug, then continued treatment as needed. Systemic concentrations of high-sensitivity cardiac troponin T and vascular endothelial growth factor were obtained at baseline, week 9, and week 24. Primary endpoint measure was change in high-sensitivity cardiac troponin T levels compared to baseline. Secondary endpoint measure was change in systemic vascular endothelial growth factor levels. Results: There was no significant difference in high-sensitivity cardiac troponin T levels over time ( p = 0.227) within each treatment group and no significant difference between treatments at any time point ( p = 0.276). There was a significant decrease in plasma vascular endothelial growth factor levels at week 9 ( p = 0.001) and week 24 ( p < 0.001) compared to baseline. In the ranibizumab group, vascular endothelial growth factor levels were not significantly different at weeks 9 and 24 compared to baseline ( p = 0.708 and p = 0.117, respectively). There was a significant association between the number of bevacizumab injections from weeks 8 to 24 and the decrease in vascular endothelial growth factor levels at week 24 ( R = −0.67, p = 0.032). This correlation was not observed in the ranibizumab group ( R = −0.341, p = 0.141). Conclusion: Repeated intravitreal bevacizumab or ranibizumab did not influence serum high-sensitivity cardiac troponin levels. Intravitreal bevacizumab but not ranibizumab lowered free-systemic vascular endothelial growth factor levels, which was observed in this study to be inversely related to the number of bevacizumab injections.

Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy

“…In a prospective study of 40 patients receiving monthly injections of either intravitreal bevacizumab or ranibizumab, there were no signs of cardiotoxicity as measured by cardiac troponin T levels and a decrease in plasma VEGF levels that correlated with the number of injections. However, the decrease in VEGF levels was only statistically significant in the bevacizumab group at Week 24 [ 17 ].…”

Hypertensive cerebral hemorrhage with undetectable plasma vascular endothelial growth factor levels in a patient receiving intravitreal injection of aflibercept for bilateral diabetic macular edema: a case report

“…Anti-VEGF therapy is also widely recommended to maintain visual functioning in patients with age-related macular degeneration, retinal vein occlusion, myopic choroidal neovascularization, and DME [ 1 , 2 ]. Large clinical studies [ 3 – 6 ] have confirmed the safety of anti-VEGF therapy, but some meta-analyses [ 7 ] indicate a high risk of systemic adverse events after repeated intravitreal anti-VEGF therapy for DME. This inconsistency may result from the study design strategy because large studies are often limited to patients with relatively fewer and minor complications and exclude patients at risk for the worst adverse events such as cerebrovascular and arteriothrombotic events [ 4 , 8 ].…”