Circulating Biomarkers for Cardiotoxicity Risk Prediction

Gong, Fei; Cascino, Gregory J; Murtagh, Gillian; Akhter, Nausheen

doi:10.1007/s11864-021-00845-0

Cited by 10 publications

(11 citation statements)

References 76 publications

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“…Elevated levels of cardiovascular biomarkers, such as hs-TNT or NT-proBNP are encountered mostly in solid cancer types. Slightly elevated hs-TnT levels are frequent findings among hospitalized patients, mostly unrelated to ACS ( 1 ). Heart failure, myocarditis, pulmonary embolism, sepsis or kidney failure are some of the most diagnosed clinical conditions ( 3 , 5 , 6 ).…”

Section: Discussionmentioning

confidence: 99%

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Basic cardiovascular risk assessment in naïve patients with colon cancer

et al. 2022

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Cardiovascular assessment of oncological patients suggests that cancer can lead to subclinical damage of the heart. The aim of the present study was to analyze the value of baseline cardiovascular biomarkers in patients with newly diagnosed colon cancer prior to treatment. Additionally, another aim was to establish baseline cut-off alert values for this low-intensity neoplastic damage. A total of 51 patients with newly diagnosed colon cancer, without history of cardiac disease, were enrolled in a prospective, cross-sectional study. All patients underwent clinical, biochemical and basic echocardiographic evaluation before starting treatment. Patients were assessed for myocardial damage using high-sensitivity troponin T (hs-TnT), creatine kinase-MB (CK-MB) and N-terminal-pro B-type natriuretic peptide (NT-proBNP). A group of 28 healthy controls was included for comparison. Cardiac ultrasound revealed similar left ventricular (LV) ejection fraction but enlarged LV chambers compared with the control group (LV at end systole, 29.50 vs. 26.00 mm; LV at end diastole, 44.50 vs. 38.00 mm; P<0.001 in both cases). The levels of cardiovascular biomarkers of myocardial damage were higher in the patients than in the control group (CK-MB, 17.00 vs. 11.00 IU/l, P<0.001; hs-TnT, 8.20 vs. 3.00 ng/l, P<0.001; 155.40 vs. 48.50 pg/ml, P=0.001). In multivariate analysis, CK-MB and hs-TnT retained statistical significance (P= 0.004 and P= 0.045, respectively). Moreover, it was demonstrated that new cut-offs for hs-TnT (8.00 ng/l) and NT-proBNP (220.00 pg/ml) can identify cardiac damage in patients ≥65 years old. Thus, the present study confirmed the hypothesis that a basic cardiovascular assessment of treatment-naïve patients with colon cancer can identify important pre-treatment myocardial impact. Adapted cut-off values should be set for cardiovascular biomarkers in the cancer population, different from those currently accepted for acute coronary syndromes or heart failure.

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Section: Discussionmentioning

confidence: 99%

“…Cardiovascular disease and cancer are two of the most important contributors of morbidity and mortality in the European Union and worldwide ( 1 ). Although the heart may be affected by cancer therapy, it has been suggested that cancer itself is responsible for a subclinical degree of cardiovascular damage in certain patients ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Basic cardiovascular risk assessment in naïve patients with colon cancer

et al. 2022

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“…Tissue damage generally results from the activation of cytokine release syndrome (CRS), which is described in most patients and can be directly linked to fatal adverse events. Clinical presentation ranges from mild flu-like symptoms to severe multiorgan failure with capillary leakage with microcirculatory imbalance [ 1 , 4 , 5 , 6 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] ( Table 1 ). CRS usually develops after a few days from CAR-T-cell infusion (about two days), with the highest risk of severe reactions during the first two weeks of treatment [ 4 , 9 , 11 , 12 , 20 ].…”

Section: Pathophysiology Of Car-t-related Cardiac Damagementioning

confidence: 99%

“…IL-6 also has a direct role in affecting cardiac microvasculature and contraction. The inflammatory milieu promotes capillary leakage, microvascular dysfunction, and increased capillary permeability, exacerbating inflammatory response, which enhances the production of procoagulant factors (such as the von Willebrand factor), causing microvascular obstruction [ 1 , 4 , 5 , 6 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Section: Pathophysiology Of Car-t-related Cardiac Damagementioning

confidence: 99%

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Cardiotoxicity of Chimeric Antigen Receptor T-Cell (CAR-T) Therapy: Pathophysiology, Clinical Implications, and Echocardiographic Assessment

Nenna

Carpenito

Chello

et al. 2022

IJMS

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Contemporary anticancer immunotherapy with chimeric antigen receptor T-cell (CAR-T) therapy has dramatically changed the treatment of many hematologic malignancies previously associated with poor prognosis. The clinical improvement and the survival benefit unveiled the risk of cardiotoxicity, ranging from minimal effects to severe cardiac adverse events, including death. Immunotherapy should also be proposed even in patients with pre-existing cardiovascular risk factors, thereby increasing the potential harm of cardiotoxicity. CAR-T therapy frequently results in cytokine release syndrome (CRS), and inflammatory activation is sustained by circulating cytokines that foster a positive feedback mechanism. Prompt diagnosis and treatment of CAR-T cardiotoxicity might significantly improve outcomes and reduce the burden associated with cardiovascular complications. Clinical and echocardiographic examinations are crucial to perform a tailored evaluation and follow-up during CAR-T treatment. This review aims to summarize the pathophysiology, clinical implications, and echocardiographic assessment of CAR-T-related cardiotoxicity to enlighten new avenues for future research.

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