Anthracycline‐induced cardiotoxicity in diffuse large B‐cell lymphoma: NT‐proBNP and cardiovascular score for risk stratification

Ferraro, Mariana; Gimeno-Vázquez, Eva; Subirana, Isaac; Gómez, Miquel; Díaz, Javier López; Sánchez‐González, Blanca; García-Pallarols, Francesc; Martínez, L.; Blé, Mireia; Molina, Lluís; Belarte, L; Abella, Eugènia; Elosúa, Roberto; Comín‐Colet, Josep; Salar, Antonio

doi:10.1111/ejh.13234

Cited by 17 publications

(15 citation statements)

References 33 publications

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“…In this study, we report a high incidence of emerging CVD, where almost one fourth (23.2%) of DLBCL patients receiving immunochemotherapy develop CVD. Previous studies show an incidence of emerging heart toxicity of 10-20% for AC or DXR treated cancer and lymphoma patients [17,18,21,[40][41][42][43]. Our result of 15.9%, with a quite long follow up time, fits into these results, despite the fact that our cases were clinically evident disease, whereas in some studies cases of silent heart failure only observed in ultrasound measurements were also included [21,40,41].…”

Section: Discussionsupporting

confidence: 79%

“…In DXR treated malignancies, some studies point at the possibility of using Troponin I as a predictor for heart failure, but find little evidence of the usefulness of NT-proBNP [17][18][19][20]. Contradictory to this, NT-proBNP improves the prediction of DXR induced cardiotoxicity when used in combination with a clinical risk score assessment function (FRESCO) in DLBCL [21].…”

Section: Introductionmentioning

confidence: 99%

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Plasma proteome profiling of cardiotoxicity in patients with diffuse large B-cell lymphoma

et al. 2021

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Background Cardiovascular toxicity is a notorious complication of doxorubicin (DXR) therapy for diffuse large B-cell lymphoma (DLBCL). Although surveillance of well-known biological markers for cardiovascular disease (CVD) as NTproBNP and Troponins may be helpful, there are no established markers to monitor for evolving CVD during treatment. New possibilities have arisen with the emergence of newer techniques allowing for analysis of plasma proteins that can be associated with cardiovascular disease. Proximity Extension Assay is one of them. Objectives We aimed to illustrate the incidence of CVD in DLBCL patients treated with DXR and to establish whether there are plasma proteins associated with pre-existing or emerging CVD. Methods In 95 patients, 182 different proteins from OLINK panels, NTproBNP, Troponin I and CRP were assessed prior to, during and after treatment. For comparison, samples from controls were analyzed. Results In the DLBCL cohort, 33.3% had pre-treatment CVD compared to 5.0% in the controls and 23.2% developed new CVD. Of the 32.6% who died during follow up, CVD was the cause in 4 patients. Spondin-1 (SPON-1) correlated to pre-treatment CVD (1.22 fold change, 95% CI 1.10–1.35, p = 0.00025, q = 0.045). Interleukin-1 receptor type 1 (IL-1RT1) was associated to emerging CVD (1.24 fold change, 95% CI 1.10–1.39, p = 0.00044, q = 0.082). Conclusion We observed a higher prevalence of CVD in DLBCL patients compared to controls prior to DXR therapy. Two proteins, SPON-1 and IL-1RT1, were related to pre-existing and emerging CVD in DXR treated patients. If confirmed in larger cohorts, IL-1RT1 may emerge as a reliable biomarker for unfolding CVD in DLBCL.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Plasma proteome profiling of cardiotoxicity in patients with diffuse large B-cell lymphoma

et al. 2021

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“…Ferraro et al suggested 600 pg/ml as the cutoff value. They showed that patients with the NT-proBNP level of more than 600 pg/ml had 3.97 times higher risk of cardiac toxicity [ 43 ]. NT-proBNP elevation may stem from other reasons more than cardiac toxicity such as altered cardiac loading conditions and invalidate the use of NT-proBNP for detection of cardiac toxicity [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity

Mahjoob

Sheikholeslami

Dadras

et al. 2020

CHDDT

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Background:: Anthracyclines, a widely used chemotherapy agent with a definite survival improvement, can result in cardiac toxicity presenting with HF (heart failure). Objective:: We aim to assess the predictive value of cardiac biomarkers assessment in combination with myocardial two-dimensional strain echocardiography for early detection of cardiac toxicity in patients who underwent Anthracycline-based chemotherapy. Method:: Fifty-two consecutive adult patients scheduled to undergo the first course of Anthracycline-based chemotherapy were subjected to the study. All the patients underwent highly sensitive 2D echocardiographic evaluation before the treatment, 4 and 12 weeks after completion of first-course chemotherapy. Longitudinal and segmental strains were measured. Serum levels of High-sensitive cardiac troponin I (hscTn-I) and N-terminal-pro-BNP (NT-proBNP) were also assessed before the initiation and 3 weeks after completion of first-course chemotherapy. Result:: Fifteen patients (28.8%) revealed a decrease in LVEF (Left Ventricular Ejection Fraction) throughout the evaluations, while just 5 patients met the criteria of cardiac toxicity (9.6%). AUC for Global Longitudinal Strain (GLS) ROC curve at 4 weeks of follow-up was calculated to be 0.968. Inferoseptal Systolic Longitudinal Strain (SLS) had the highest AUC value (AUC: 0.934) among different wall SLS. LVESD (Left Ventricular End-Systolic Diameter) at first and second evaluation could predict the risk of cardiac toxicity among LVESD, LVEDD (Left Ventricular End Diastolic Diameter) and LVEDV (Left Ventricular End-Diastolic Volume). Among cardiac biomarkers, hscTnI had higher sensitivity, while NT-proBNP had higher specificity for cardiac toxicity. Conclusion:: This study has shown that hs-cTnI with good sensitivity can predict cardiac toxicity in Anthracycline-based chemotherapy receiver. The use of strain with speckle echocardiography method has a prognostic value; however, both longitudinal and segmental strain should be assessed. Lateral and inferoseptal SLS (Segmental Longitudinal Strain) are specific markers of cardiac toxicity in the course of anthracycline-related cardiac toxicity.

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“…With anthracycline chemotherapy playing a prominent role in lymphoma treatment, DLBCL patients' prognoses continue to improve because of earlier detection and newer targeted therapeutic drugs. With longer survivorship, there will be a large number of DLBCL patients who will have to face the risk of cardiovascular morbidity and mortality which caused by long-term toxicity of anthracycline chemotherapy [25][26][27][28]. Cardiotoxicity caused by anthracycline is often progressive and irreversible, which The QTc interval on the electrocardiogram (ECG) refers to the QT interval corrected according to heart rate or RR interval [32].…”

Section: Discussionmentioning

confidence: 99%

Summed rest score in gated myocardial perfusion imaging is a good predicator for treatment-related cardiotoxicity after anthracycline chemotherapy in diffuse large B-cell lymphoma patients

Yang¹,

Wang²,

Xu³

et al. 2020

Preprint

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Background: Anthracycline chemotherapy is commonly used in the treatment of diffuse large B-cell lymphoma (DLBCL) patients. Treatment-related cardiotoxicity (TRC) may be observed during treatment and may induce severe cardiac failure or cardiac arrhythmia as the main cause of death, even several years after chemotherapy implementation. Herein, we performed a study to investigate the prognostic value of gated myocardial perfusion imaging (G-MPI) summed rest score (SRS) for the early detection of TRC caused by anthracycline chemotherapy in DLBCL patients.Methods: A total of 36 DLBCL patients were enrolled, and a series of parameters from the same individual patient were compared between baseline and after the end of the 6th R-CHOP chemotherapeutic regimen. According to whether TRC occurred during the observation period, the patients were divided into two groups, and parameters related to cardiac function were compared.Results: SRS in G-MPI and QTc interval in electrocardiogram were significantly different before and after chemotherapy (P = 0.012 and P = 0.015, respectively).By comparing parameters related to cardiac function between the TRC group (n = 22) and the no-TRC group (n = 14), only SRS was significantly different (P = 0.012). Multivariate logistic regression analysis showed that the SRS level was the only independent predicator for TRC (P = 0.018, HR = 6.053, 95% CI: 1.364-26.869). Receiver operating characteristic curve analysis identified an optimal SRS cutoff of >1for predicting TRC after anthracycline chemotherapy (P＜ 0.001).Conclusion: The G-MPI SRS level was an early indicator for TRC surveillance in DLBCL patients after anthracycline chemotherapy, thus contributing to early treatment and a subsequent decrease in mortality caused by such cardiovascular complications.

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Anthracycline‐induced cardiotoxicity in diffuse large B‐cell lymphoma: NT‐proBNP and cardiovascular score for risk stratification

Cited by 17 publications

References 33 publications

Plasma proteome profiling of cardiotoxicity in patients with diffuse large B-cell lymphoma

Plasma proteome profiling of cardiotoxicity in patients with diffuse large B-cell lymphoma

Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity

Summed rest score in gated myocardial perfusion imaging is a good predicator for treatment-related cardiotoxicity after anthracycline chemotherapy in diffuse large B-cell lymphoma patients

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