BNP cannot replace gated equilibrium radionuclide ventriculography in monitoring of anthracycline-induced cardiotoxity

Vogelsang, Thomas; Jensen, Rigmor; Hesse, Birger; Kjær, Andreas

doi:10.1016/j.ijcard.2007.02.003

Cited by 25 publications

(27 citation statements)

References 12 publications

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“…RNV and echocardiography are the main instruments for the detection of cardiac toxicity. Whereas highly accurate quantification of the decline in systolic function can be carried out by RNV, echocardiography offers advantages when anthracycline-induced diastolic dysfunction is also in question [15,16]. As expected, our study reveals that epirubicincontaining adjuvant chemotherapy may result in cardiac toxicity one year after the completion of therapy.…”

Section: Discussionsupporting

confidence: 75%

Cardiac troponin T for early detection of cardiotoxicity in breast cancer patients treated with epirubicin

et al. 2009

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AbstractThe aim of the study was to investigate the role of cTnT for the prediction of long term cardiac dysfunction after epirubicin-containing adjuvant chemotherapy for breast cancer. The study group comprised of 45 patients (all female; mean age 48 ±8 years), treated with epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer. Patients received either 4 cycles of cyclophosphamide plus epirubicin (90 mg/m2) (n=23; stage 2 breast cancer) or 6 cycles of cyclophosphamide plus epirubicin (75 mg/m2) plus fluorouracil (n=18; stage 3 breast cancer). Venous blood samples were drawn, before and 72 hours after, every cycle of chemotherapy for the measurement of cTnT. Cardiac assessment was carried out at baseline and 1 year after chemotherapy by clinical evaluation, electrocardiography, radio-nuclide ventriculography (RNV) and transthoracic echocardiography. All patients remained free of clinical heart failure during the study period. In 26 patients (63%), cTnT was elevated after chemotherapy. Mean left ventricular ejection fraction, assessed by RNV at baseline and one year after chemotherapy, were 61±8% and 56±7% (p<0.0001). The sensitivity and specifity of cTnT for the detection of left ventricular systolic dysfunction at one year were 69% and 39% respectively. Echocardiographic examinations at baseline and one year after chemotherapy revealed a significant decrease in E/A ratio from 1.15±0.3 to 0.9±0.2 in cTnT positive patients, suggesting diastolic dysfunction. In conclusion, elevated serum cTnT levels after epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer, predict future cardiac dysfunction with moderate sensitivity and poor specificity.

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Section: Discussionsupporting

confidence: 75%

Cardiac troponin T for early detection of cardiotoxicity in breast cancer patients treated with epirubicin

et al. 2009

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“…Although several studies have found increases in these biomarkers after anthracycline therapy, the predictive value of these increases has not been consistent, and concerns about their variability and specificity in this population have been raised. Several studies have reported an association of BNP levels with simultaneously decreased LVEF (30,149,203) although some investigators have not (123,147). Most investigators who have investigated the predictive value of BNP or NTproBNP in the detection of subsequent cardiotoxicity have reported negative results (30,34,71,91,92,166).…”

Section: Other Biomarkersmentioning

confidence: 99%

Anthracycline‐Induced Cardiomyopathy in Adults

Tan

Neilan

Francis

et al. 2015

Comprehensive Physiology

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Anthracyclines are one of the most commonly used antineoplastic agent classes, and a core part of the treatment in breast cancers, hematological malignancies, and sarcomas. Their benefit is decreased by their well-recognized cardiotoxicity. The purpose of this review is to outline the presentation, mechanisms, diagnosis, and treatment of anthracyclines-induced cardiotoxicity. Symptomatic heart failure occurs in 2% to 5% of patients treated with anthrayclines and may be higher in older patients or patients with cardiovascular risk factors. The mechanisms involved in anthracycline-induced cardiotoxicity involve myocyte loss by apoptosis in the presence of a limited regenerative capacity. Once symptomatic, anthracycline-induced cardiotoxicity is associated with markedly decreased survival. Left ventricular ejection fraction (LVEF), mostly determined using echocardiography, is used to monitor patients treated with anthracyclines. As more than 1/3 of patients treated with anthracyclines do not recover their baseline LVEF once it is decreased, more sensitive echocardiographic indices of LV function such as myocardial deformation or biomarkers have been studied in patients monitoring. Cardioprotective treatments such as angiotensin-converting enzyme inhibitors, beta-blockers, iron chelators, statins, and metformin are also the topic of research efforts.

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“…one study found that BnP had a fairly poor sensitivity for detecting asympto matic decreases in lveF. 57 A small study (n = 53) found that baseline elevation of BnP, which implies preexisting subclinical cardiac disease, was associated with decreased REviEwS lveF at 2 years. 58 Although cardiac troponins and BnP might be beneficial for early identification of highrisk patients who require treatment or alteration of chemo therapeutic strategies, these biomarkers cannot currently substitute imaging modalities for measurement of lveF, and further validation is needed prior to their widespread use and incorporation into anticancer protocols.…”

Section: Doxorubicinmentioning

confidence: 98%

Cardiotoxicity of anticancer treatments: what the cardiologist needs to know

2010

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Cardiotoxicity of anticancer treatments has become an increasingly important clinical problem faced by cardiologists. Left ventricular systolic dysfunction and heart failure generate the most concern, but clinical features and prognosis vary considerably depending on the causative agent. Anthracycline-related cardiomyopathy differs fundamentally from effects associated with newer targeted agents, such as trastuzumab. Other forms of cardiovascular disease that occur as a result of cancer treatment include hypertension, thromboembolic disease, pericardial disease, arrhythmia, and myocardial ischemia. The approach to cardiovascular disease in patients with cancer is often different from that in the general population, not only because of distinct underlying mechanisms and clinical features of their heart disease, but also because of the potential ongoing need for additional cancer treatment as well as the altered duration of anticipated survival. In an effort to maximize both quality of life and survival, cardiologists and oncologists should collaborate with the aim of balancing the risks of cardiotoxicity with the benefits of oncologic therapy.

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BNP cannot replace gated equilibrium radionuclide ventriculography in monitoring of anthracycline-induced cardiotoxity

Cited by 25 publications

References 12 publications

Cardiac troponin T for early detection of cardiotoxicity in breast cancer patients treated with epirubicin

Cardiac troponin T for early detection of cardiotoxicity in breast cancer patients treated with epirubicin

Anthracycline‐Induced Cardiomyopathy in Adults

Cardiotoxicity of anticancer treatments: what the cardiologist needs to know

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