Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy

Cardinale, Daniela; Sandri, Maria Teresa; Martinoni, Alessandro; Borghini, Elena; Civelli, Maurizio; Lamantia, Giuseppina; Cinieri, Saverio; Martinelli, G.; Fiorentini, Cesare; Cipolla, Carlo M.

doi:10.1093/annonc/mdf170

Cited by 269 publications

(175 citation statements)

References 27 publications

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“…Differentiation between "normal" and "clinically relevant" functional impairment was made by considering as a pathologic value a decrease in LVEF below the 10th percentile of the distribution of the changes of LVEF. According to previous experience (21,26 ), values below the 10th percentile are associated with clinically relevant decreases in ejection fraction (27 ).…”

Section: Discussionmentioning

confidence: 94%

Minor Increases in Plasma Troponin I Predict Decreased Left Ventricular Ejection Fraction after High-Dose Chemotherapy

Sandri¹,

Cardinale²,

Zorzino³

et al. 2003

Clinical Chemistry

105

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Background: Increased cardiac troponin I (cTnI) in patients treated with high-dose chemotherapy (HDCT) for aggressive malignancy has been proposed as an early marker of late HDCT-induced cardiac dysfunction. We investigated whether cTnI measured by the Stratus CS (Dade Behring) would allow detection of minimal cTnI increases in patients treated with HDCT. Methods: Plasma cTnI concentrations were determined in 179 consecutive patients before HDCT, at the end of the treatment, and after 12, 24, 36, and 72 h. Cardiac function was explored by echocardiography, and left ventricular ejection fraction (LVEF) was recorded during follow-up. The greatest variation in LVEF from the baseline value was used as a measure of cardiac damage. Results: In 99 healthy volunteers, the 99th percentile was at 0.07 g/L. On the basis of ROC curve analysis (area under the curve, 0.89), a cutoff of 0.08 g/L was chosen (sensitivity, 82%; specificity, 77%). cTnI >0.08 g/L occurred in 57 patients (32%) with echocardiographic monitoring revealing a mean decrease in LVEF of 18%. In comparison, the group of cTnI-negative patients had a mean decrease in LVEF of 2.5% (P <0.001). Conclusions: Plasma cTnI, as measured with the Stratus CS, can detect minor myocardial injury in patients treated with HDCT.

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Section: Discussionmentioning

confidence: 94%

Minor Increases in Plasma Troponin I Predict Decreased Left Ventricular Ejection Fraction after High-Dose Chemotherapy

Sandri¹,

Cardinale²,

Zorzino³

et al. 2003

Clinical Chemistry

105

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“…Cardiac troponins are sensitive markers of myocardial injury with both troponin I (Tn-I) and T (Tn-T) assays. Cardinale et al demonstrated that the timing and degree of Tn-I rise was predictive of developing LV dysfunction, and also correlated with anthracycline cumulative dosing [43][44][45][46]. Tn-I monitoring also served effectively as risk stratification in their studied population; patients treated with high-dose chemotherapy who developed an increased in Tn-I were the ones who benefited more from the initiation of an angiotensin-converting enzyme inhibitor treatment (enalapril), preventing LVEF decrease [47].…”

Section: Circulating Biomarkersmentioning

confidence: 99%

“…In regards to biomarkers, troponin levels appear to have the best predictive value in detecting cardiotoxicity monitoring, with the timing and the degree of the rise correlated with risk of CTRCD [43][44][45][46]. Troponin elevations during treatment also identify a high risk cohort of cancer patients who may benefit from early cardioprotective medication [47].…”

Section: Proposed Multimodality Imaging Strategiesmentioning

confidence: 99%

Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity

2017

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Contemporary cancer management has increased the overall number of cancer survivors, but cardiotoxicity remains a subject of concern, which is a major cause of noncancer mortality among survivors. Among the potential cardiovascular complications, left ventricular (LV) systolic dysfunction is a poor prognostic factor. The importance of its early detection is based on the principle that the likelihood of response to heart failure (HF) treatment is temporally related to the initiation of HF treatment. For these reasons, cardiac monitoring is commonly applied in general practice, based on serial measurements of LV ejection fraction (LVEF); transthoracic echocardiography (TTE) is generally used. However, the LVEF, as a diagnostic and predictive parameter, has significant limitations, which calls for more effective multimodality imaging strategies. This approach requires further study, but there is increasing available data in the literature, encouraging the combination of multimodality imaging parameters and techniques for early cancer therapeutic-related cardiac dysfunction (CTRCD) detection.

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“…The clinical application of cardiac troponins as cardiotoxicity biomarkers was analyzed in 7 clinical studies with a consistent number of subjects (> 40 patients enrolled) monitored by cardiac troponin I (cTnI) or cardiac troponin T (cTnT), for the total number of almost 1 500 adult patients treated with CT for cancer [34][35][36][37][38][39][40]. See Table 2.…”

Section: Cardiac Troponins As Markers Of Ct-induced Cardiotoxicitymentioning

confidence: 99%

Biomarkers of Cardiac Injury in Detection of Cardiotoxicity Induced by Chemotherapeutic Agents

Horáček¹

2011

Mil. Med. Sci. Lett.

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SummaryCardiotoxicity is a well-known and potentially serious complication of oncology treatment. Anthracyclines and high-dose chemotherapy especially regimens containing high-dose Cyclophosphamide represent the greatest risk. Early detection of cardiotoxicity is crucial for applying preventive and supportive therapeutic strategies. Various methods have been recommended for monitoring of cardiotoxicity. In our conditions, echocardiography and electrocardiography are routinely used. However, this approach shows low sensitivity for the early prediction of cardiomyopathy when the possibilities of appropriate management could still improve the patient's outcome.Recently, biomarkers of cardiac injury have been investigated in the assessment of chemotherapy-induced cardiotoxicity. Cardiospecific biomarkers, such as cardiac troponins, show high diagnostic efficacy in the early subclinical phase of the disease before the clinical onset of cardiomyopathy. The increase in their concentrations correlates with disease severity. As for natriuretic peptides, some studies, including ours, have shown promising results. Definitive evidence of their diagnostic and prognostic role in this context is still lacking and natriuretic peptides have not been routinely used for monitoring of cardiotoxicity in clinical practice. Other perspective biomarkers of cardiotoxicity in oncology are under study, especially heart-type fatty acid-binding protein (H-FABP) and glycogen phosphorylase BB (GPBB). Our studies using GPBB have brought priority and encouraging results. However, the available data are limited and their practical use in this context cannot be recommended until their clinical efficacy is clearly defined.The author presents his own experience with multiple biomarkers of cardiac injury in the detection of cardiotoxicity associated with conventional and high-dose chemotherapy for hematological malignancies.

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Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy

Abstract: In our population, the elevation of TnI soon after HDC accurately predicts the development of future LVEF depression. In this setting, TnI can be considered a sensitive and reliable marker of myocardial damage with relevant clinical and prognostic implications.

Cited by 269 publications

References 27 publications

Minor Increases in Plasma Troponin I Predict Decreased Left Ventricular Ejection Fraction after High-Dose Chemotherapy

Minor Increases in Plasma Troponin I Predict Decreased Left Ventricular Ejection Fraction after High-Dose Chemotherapy

Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity

Biomarkers of Cardiac Injury in Detection of Cardiotoxicity Induced by Chemotherapeutic Agents

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