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

Abstract

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.

Cardiac Troponin I Predicts Elevated B-type Natriuretic Peptide in Patients Treated with Anthracycline-Containing Chemotherapy

“…This threshold level of TnI to detect AIC is in agreement with a previous report by Sawaya et al [20]. A recently published meta-analysis revealed that elevated troponin levels predicted LV dysfunction in patients receiving anthracyclines, but BNP did not [21]. Long-term follow-up data are required to confirm whether elevated BNP is associated with cardiac dysfunction in the chronic phase.…”

Cardiovascular adverse events in patients with non-Hodgkin lymphoma treated with first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP with rituximab (R-CHOP): a systematic review and meta-analysis

“…Additional to standard LVEF measurements, deformation imaging by means of global longitudinal strain has shown promising results to detect early changes in myocardial contractility in this setting 52 . Other screening methods include biomarkers, of which the most promising is troponin with a negative predictive value of 93% 53 . For primary prevention, ACE-inhibitors and beta-blockers have been studied in breast cancer patients in a small number of trials with limited sample size 54,55 .…”

February 2020 at a glance: acute heart failure and cardio‐oncology

“…Finally, a meta-analysis including 61 studies and 5691 patients on cancer therapy showed that troponin, but not natriuretic peptide levels, predicts cancer therapyrelated left ventricular dysfunction and that HF therapies decrease troponin levels. 19…”