High Sensitivity Troponin T as Complementary Modality for Determining Doxorubicin Regimen Cardiotoxicity in Non-Hodgkin Lymphoma Patients

Abstract

Purpose: This study aims to evaluate the role of high-sensitivity troponin T (hsTnT) as a complementary tool for determining cardiotoxicity in non-Hodgkin lymphoma (NHL) patients receiving cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) regimen chemotherapy. Methods: We included 35 patients diagnosed with NHL who received CHOP chemotherapy. Left ventricular ejection fraction (LVEF) and hsTnT were measured at two time points: before the first cycle (pre-test) and after the fourth cycle (post-test). The LVEF and hsTnT were analysed using IBM SPSS version 24 through the paired-sample T-test, Wilcoxon signed-rank test, Pearson’s correlation and Spearman’s correlation. Results: There was a significant difference in both LVEF and hsTnT between pre-chemotherapy and post-4th chemotherapy cycles (p = 0.001). However, more contrast difference from the baseline value of hsTnT compared to LVEF could be observed. LVEF did not detect any deterioration in myocardial function. However, 10 out of 35 subjects exhibit hsTnT higher than the 99th percentile of the population (>14 pg/ml), suggesting that myocardial injury (MI) could be detected. There was no correlation between LVEF and hsTnT (p > 0.05). Conclusion: HsTnT, together with LVEF, could complement each other and offer better coverage for detecting cardiotoxicity during the administration of CHOP in NHL patients. An insignificant correlation between hsTnT and LVEF showed that cardiotoxicity existed in a broad spectrum including cellular damage and functional impairment, as hsTnT represents cellular damage, and LVEF reflects heart functional capacity.

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

“…However, when the detection time point was 3–6 months, the AUC increased to 0.90 (95% CI: 0.87–0.92), indicating a high early diagnostic value. This finding is consistent with results of previous studies 11,13,15,28 . Meta‐regression analysis showed that ethnicity and detection time point of hs‐cTnT were the main sources of heterogeneity, and sensitivity analysis showed that I 2 for sensitivity and specificity decreased to 30.46 (95% CI: 0.00–89.58) and 86.52 (95% CI: 77.86–95.17), respectively, after the exclusion of the study by Finke et al 20 .…”

“…This finding is consistent with results of previous studies. 11,13,15,28 Meta-regression analysis showed that ethnicity and detection time point of hs-cTnT were the main sources of heterogeneity, and sensitivity analysis showed that I 2 for sensitivity and specificity decreased to 30.46 (95% CI: 0.00-89.58) and 86.52 (95% CI: 77.86-95.17), respectively, after the exclusion of the study by Finke et al 20 This observation might result from different cut-off thresholds, study designs, patient populations, and treatments. Hs-cTnT had a PLR of 3.1 (95% CI: 1.8-5.4) and an NLR of 0.29 (95% CI: 0.17-0.50) for CTRCD diagnosis, suggesting that although the accuracy of diagnosing CTRCD patients was 3.1 times higher than that of judging healthy subjects, 29% of CTRCD patients might be missed.…”

“…In a cardiotoxicity assay of 35 patients with non-Hodgkin's lymphoma (NHL) receiving chemotherapy with cy-clophosphamide, adriamycin, vincristine, and prednisone (CHOP), the overall hs-cTnT levels had increased significantly during the fourth cycle of chemotherapy (every 21 days) when LVEF did not show any abnormalities. 15 In a study of 225 patients with non-small cell lung cancer (NSCLC), elevated hs-cTnT levels during concurrent dual chemotherapy with platinum and paclitaxel and chest radiotherapy were dependent on radiation heart dose. Hs-cTnT levels were associated with CTRCD and mortality, and routine monitoring of hs-cTnT could identify patients at high risk of CTRCD due to radiotherapy at an early stage.…”

“…analysed 61 trials with 5691 patients and showed that troponin had a negative predictive value of 93% for CTRCD, with a high exclusionary diagnostic value 11 . Additionally, several studies suggested that serum high‐sensitivity troponin could be used as a marker for early monitoring of CTRCD in patients undergoing cancer chemoradiotherapy 12–24 . However, no systematic and comprehensive evaluation of the early diagnostic value of serum high‐sensitivity cardiac troponin T (hs‐cTnT) has been performed.…”

“…11 Additionally, several studies suggested that serum high-sensitivity troponin could be used as a marker for early monitoring of CTRCD in patients undergoing cancer chemoradiotherapy. [12][13][14][15][16][17][18][19][20][21][22][23][24] However, no systematic and comprehensive evaluation of the early diagnostic value of serum high-sensitivity cardiac troponin T (hs-cTnT) has been performed.…”