The use of high-sensitivity troponin T as a biomarker of anthracycline cardiotoxicity.
Anthracyclines are a very effective class of chemotherapy used to treat a wide variety of malignancies . Its use is complicated by the development of cancer treatment-related cardiac dysfunction (CT-RCD), broadly defined as the development of left ventricular systolic dysfunction after cancer treatment.
Troponin , a well-established marker of myocardial necrosis and early myocardial injury after anthracycline chemotherapy, may predict the subsequent development of CT-RCD . However, it is not known at what point troponin should be measured or whether there is a clinically relevant threshold that best predicts the development of CT-RCD.
Purpose
1. To investigate whether high-sensitivity troponin T (hsTnT) accurately predicts the development of anthracycline CT-RCD
2. Establish the best time at which hsTnT should be measured to predict CT-RCD
3. Establish the most clinically relevant hsTnT concentration to predict CT-RCD
Methods
In 2020 we introduced a clinical pathway for outpatients receiving anthracycline chemotherapy at our Institution. As part of this pathway, hsTnT concentrations are measured at baseline (before chemotherapy) and before each anthracycline cycle.
In this study, we performed a prospective audit of outpatients receiving anthracycline chemotherapy for the treatment of breast or hematologic malignancies.
Troponin concentrations were assessed before each chemotherapy cycle and ROC curve analyzes were performed to determine the most accurate time point and threshold for predicting CT-RCD. CT-RCD was defined as a drop in left ventricular ejection fraction (LVEF) of >10% from baseline to a value of <50%.
Results
118 outpatients were treated with anthracycline chemotherapy between August 2020 and May 2022. 64 patients (54%) were treated for breast cancer and 54 (46%) for hematological malignancies.
The mean age was 54±15 years, with 71% women. At the beginning of the study, 27 (23%) of the patients had a diagnosis of hypertension, 16 (14%) diabetes, 28 (24%) a history of smoking, 10 (8%) chronic kidney disease, and 31 (26%) obesity. The median cumulative dose was 360 mg/m² for epirubicin and 300 mg/m² for doxorubicin.
The mean baseline left ventricular ejection fraction (LVEF) was 60.5±4%. 97/118 (82%) patients had a follow-up echocardiogram. 11/97 (11%) patients developed CT-RCD.
Mean hsTnT concentrations gradually increased as the cumulative anthracycline dose increased (Fig. 1).
Baseline hsTnT concentration was the most accurate predictor of subsequent CT-RCD (AUC 0.75), with a sensitivity of 75% and specificity of 80% for predicting CT-RCD if baseline hsTnT concentration was ≥10.5. ng/l. Furthermore, the mean baseline concentration of hsTnT was significantly higher in patients with CT-RCD versus those without CT-RCD, P = 0.0008 (Fig. 2).
Conclusions High-sensitivity troponin T concentrations appear to be clinically useful in predicting subsequent CT-RCD, with the most accurate measurement point being the baseline value, before starting chemotherapy. |
Reference : The use of high sensitivity troponin T as a biomarker of anthracycline cardiotoxicity . C Bannister, B Tam To, T Patel, R Yap, A Cannata, D Bromage
