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Cardiac biomarkers may offer early detection of anthracycline-induced cardiotoxicity
Cardiac biomarkers troponin I and B-type natriuretic peptide may provide an effective strategy for the early detection of cardiotoxicity during anthracycline chemotherapy, researchers reported in the Journal of Cardiac Failure.
The biomarkers were a better predictor of anthracycline-related cardiac events than left ventricular ejection fraction, the researchers found.
“In light of the rapidly developing complexity of cancer chemotherapy and the burgeoning overlap between cancer therapeutic targets and impairment of myocardial metabolism and repair mechanisms, there is a clear need to establish accurate and sensitive cardiac safety standards during cancer chemotherapy,” Daniel J. Lenihan, MD, of the division of cardiovascular medicine at Vanderbilt University in Nashville, Tennessee, and colleagues wrote.
Lenihan and colleagues enrolled 97 patients who agreed to undergo cardiac biomarker assessment including troponin I and B-type natriuretic peptide (BNP) before and 24 hours after completing each anthracycline chemotherapy cycle and again at 6 months. Almost all patients had breast cancer, lymphoma or sarcoma. The planned study follow-up was 6 months, but some patients received monitoring for up to 1 year. Median follow-up was 5.9 months.
Ninety-four patients completed two or more cycles of chemotherapy during the study period. Most of the patients were white (82%), and the median age was 56 years. Fifty-two percent of patients were women.
According to the results, the mean dose of chemotherapy received by patients who had cardiac events was 267 mg/m2. At baseline, nine patients had a BNP of more than 100 pg/mL, including one patient with a BNP of 264 pg/mL. During follow-up, 11 patients experienced a cardiac event.
Three of the four patients who experienced an arrhythmia event developed atrial fibrillation, and one had nonsustained paroxysmal ventricular tachycardia. An abnormal troponin I level was found in two patients before or after a cycle of chemotherapy, and ACS was confirmed on the day they had the cardiac event.
In addition, elevated BNP values were found in both pre- and postchemotherapy assessments in patients who experienced cardiac events (P < .01 for all comparisons), except for posttreatment comparison at cycle 3 (P = .0196). All 11 patients had at least one BNP value greater than 100 pg/mL before experiencing the cardiac event, whereas reduction in LVEF alone identified three of the 11 patients with cardiac events.
While LVEF in those who had an event was lower than in those who did not (P = .05), it “was of borderline significance,” the researchers wrote.
According to Lenihan and colleagues, early detection of cardiac toxicity, particularly through the use of BNP assessment, may be an effective strategy for providing cardioprotective therapy such as ACE inhibitors and beta-blockers to prevent cardiac events related to chemotherapy. – by Tracey Romero
Disclosure: Lenihan reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.