Early diagnostic value of high‐sensitivity cardiac troponin T for cancer treatment‐related cardiac dysfunction: a meta‐analysis

Abstract

Early diagnosis of cancer treatment-related cardiac dysfunction (CTRCD) is important as cancer therapy increases the risk of cardiac dysfunction. High-sensitivity cardiac troponin T (hs-cTnT) is a highly specific marker of myocardial injury. However, its diagnostic value for CTRCD has not been systematically evaluated. This meta-analysis aimed to evaluate whether hs-cTnT could be used as an early diagnostic biomarker for CTRCD. We systematically surveyed PubMed, Embase, Cochrane Library, and Web of Science databases for studies of hs-cTnT for the diagnosis of CTRCD before 1 April 2022. Patients of all ages and all cancer types who underwent echocardiographic left ventricular ejection fraction assessment and blood hs-cTnT and received anticancer therapy (including chemotherapy, radiotherapy, targeted therapy, immune checkpoint inhibitors, and other treatments) were included in this study, resulting in a total of eight studies with 1294 patients. The occurrence of CTRCD was associated with elevated hs-cTnT [sensitivity: 0.78, 95% confidence interval (CI): 0.64-0.88; specificity: 0.75, 95% CI: 0.59-0.86; area under the curve (AUC): 0.83, 95% CI: 0.80-0.86]. We further performed subgroup analysis and found that the AUC of hs-cTnT elevation for the diagnosis of CTRCD increased from 0.83 to 0.90 (95% CI: 0.87-0.92) at 3-6 months, suggesting a higher early diagnostic value of hs-cTnT compared with echocardiography for CTRCD. In terms of clinical applicability, the Fagan plot showed pre-test and post-test probabilities of 51% and 9%, respectively, indicating that hs-cTnT testing can improve the accuracy of clinical diagnosis of CTRCD. However, it was not possible to determine the optimal cut-off value for early diagnosis of CTRCD with hs-cTnT. The Deeks funnel plot was largely symmetrical (P = 0.74); hence, publication bias was not observed. Hs-cTnT allowed early CTRCD diagnosis at 3-6 months. However, further high-quality research is needed to determine the optimal cut-off value for early CTRCD diagnosis with this biomarker.

Role of Clinical Risk Factors and B-Type Natriuretic Peptide in Assessing the Risk of Asymptomatic Cardiotoxicity in Breast Cancer Patients in Kazakhstan

“…Japanese researchers showed that early relative worsening of >15% in GLS was significantly associated with hsTnI elevation [57]. As shown recently, hs-cTnT testing can improve the accuracy of CTRCD clinical diagnosis [58].…”

Involvement of Ferroptosis Induction and Oxidative Phosphorylation Inhibition in the Anticancer-Drug-Induced Myocardial Injury: Ameliorative Role of Pterostilbene

“…Herein, we discussed the role of ferroptosis in anticancer-drug-induced myocardial injury. However, in actual clinical practice, the prediction of CTRCD via elevated blood troponin T levels is limited in sensitivity [ 51 ], suggesting that ferroptosis might not be severe enough to cause heart failure. Our study suggests that impairment of myocardial energy metabolism caused by anticancer drugs may contribute to cardiac dysfunction.…”

Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

“…In patients on immune checkpoint inhibitors, elevated conventional Tn was associated with myocarditis and the risk of MACE, including cardiovascular death, cardiogenic shock, cardiac arrest, or complete heart block [ 237 ]. Because Tn elevations can be detected prior to echocardiographic changes, the assay can allow clinicians to identify patients who require cardiotoxicity prevention or treatment and to monitor the response to therapy in patients who have developed cardiotoxicity [ 232 , 238 ].…”