‘Readily available’ biomarkers may predict cancer survivors at risk for cardiomyopathy
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Key takeaways:
- Childhood cancer survivors with abnormal global longitudinal strain and NT-proBNP had increased cardiomyopathy risk.
- New data presents better information on potential risk among asymptomatic survivors.
The combination of abnormal baseline global longitudinal strain and N-terminal-pro-B-type natriuretic peptide is associated with a more than fourfold risk for subsequent cardiomyopathy among certain childhood cancer survivors.
The data, published in Journal of Clinical Oncology, presents new potential method to identify cancer survivors with a high risk for future cardiomyopathy, according to researchers.
“One of the promising aspects of our findings is that both of these measures are readily available and, therefore, have the potential to impact care more immediately,” Matthew J. Ehrhardt, MD, MS, an associate member of St. Jude Children’s Research Hospital department of oncology faculty, said in a press release. “Most cardiologists are already using [global longitudinal strain], and [N-terminal-pro-B-type natriuretic peptide] has been around for a long time.”
Background and methodology
Researchers conducted a retrospective study comprised of 1,483 (median age, 37.6 years; range, 10.2-70.4) pediatric patietns from the St. Jude Lifetime Cohort (SJLIFE) longitudinal prospective study. They included participants who had survived at least 5 years after a childhood cancer and used baseline global longitudinal strain (GLS) and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels to identify survivors with a normal left ventricular ejection fraction at highest risk for future treatment-related cardiomyopathy.
Study participants underwent measurements of GLS (n = 1,483) and NT-proBNP (n = 1,052; 71%).
Grade 2 to grade 5 cardiomyopathy subsequent to the baseline SJLIFE evaluation served as the study’s primary outcome measurement.
Results, next steps
Of the 1,483 childhood cancer survivors included in the study, 162 (11.1%) developed grade 2 or greater cardiomyopathy 5.1 years (range, 0.7-10) from time of baseline assessment.
Researchers noted the 5-year cumulative incidence of cardiomyopathy for survivors with GLS to be 7.3% (95% CI, 4.7–9.9) and without GLS to be 4.4% (95% CI, 3–5.7). They also reported the 5-year cumulative incidence of cardiomyopathy for survivors with abnormal NT-proBNP to be 9.9% (95% CI, 5.8-14.1) and without NT-proBNP to be 4.7% (95% CI, 3.2-6.2).
Among childhood cancer survivors with a normal left ventricular ejection fraction, researchers observed that abnormal baseline GLS and NT-proBNP identified anthracycline-exposed, moderate- to high-risk survivors at a fourfold increased hazard for postbaseline cardiomyopathy (HR = 4.39; 95% CI, 2.46-7.83). The risk increased to more than 14-fold (HR = 14.16; 95% CI, 6.45-31.08) among study participants who received 250 mg/m2 of anthracyclines.
The results, according to researchers, can assist oncologists in better predicting cardiomyopathy within 5 years than routine clinical evaluation among high-risk, asymptomatic childhood cancer survivors, thus leading to better treatment against heart damage.
“This may be a much more sensitive way to identify childhood cancer survivors that might benefit from intervention at an earlier stage,” Ehrhardt said in the release. “We were somewhat surprised by the magnitude of risk for declining heart function over such a relatively short period in individuals with abnormal GLS and NT-proBNP, suggesting a need for early and effective interventions that we hope will prevent progression to heart failure over time.”
References:
- Ehrhardt MJP, et al. J Clin Oncol. 2024;doi:10.1200/JCO.23.01796.
- Two common biomarkers predict heart risk in asymptomatic childhood cancer survivors (press release). Available at: https://www.stjude.org/media-resources/news-releases/2024-medicine-science-news/two-common-biomarkers-predict-heart-risk-in-asymptomatic-childhood-cancer-survivors.html. Published Jan. 11, 2024. Accessed March 7, 2024.
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