Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity

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Author(s): Mohammad Parsa Mahjoob, Seyed Amir Sheikholeslami, Morvarid Dadras, Hamdollah Mansouri, Mahshid Haghi, Mohammadreza Naderian, Leila Sadeghi, Mohammadreza Tabary*, Isa Khaheshi*.

Journal Name: Cardiovascular & Hematological Disorders-Drug Targets
(Formerly Current Drug Targets - Cardiovascular & Hematological Disorders)

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Background: Anthracyclines, a widely used chemotherapy agent with a definite survival improvement, can result in cardiac toxicity presenting with HF (heart failure)

Objective: We aim to assess the predictive value of cardiac biomarkers assessment in combination with myocardial two-dimensional strain echocardiography for early detection of cardiac toxicity in patients who underwent Anthracycline-based chemotherapy.

Method: Fifty-two consecutive adult patients scheduled to undergo the first course of Anthracycline-based chemotherapy were subjected to the study. All the patients underwent highly sensitive 2D echocardiographic evaluation before the treatment, 4 and 12 weeks after completion of first-course chemotherapy. Longitudinal and segmental strains were measured. Serum levels of High-sensitive cardiac troponin I (hscTn-I) and N-terminal-pro-BNP (NT-proBNP) were also assessed before the initiation and 3 weeks after completion of first-course chemotherapy.

Result: Fifteen patients (28.8%) revealed a decrease in LVEF (left ventricular ejection fraction) throughout the evaluations, while just 5 patients met the criteria of cardiac toxicity (9.6%). AUC for global longitudinal strain (GLS) ROC curve at 4 weeks of follow-up was calculated to be0.968. Inferoseptal Systolic longitudinal strain (SLS) had the highest AUC value (AUC: 0.934) among different wall SLS. LVESD (left ventricular end-systolic diameter) at first and second evaluation could predict the risk of cardiac toxicity among LVESD, LVEDD (left ventricular end diastolic diameter) and LVEDV (left ventricular end-diastolic volume). Among cardiac biomarkers, hs-cTnI had higher sensitivity, while NT-proBNP had higher specificity for cardiac toxicity.

Conclusion: This study has shown that hs-cTnI with good sensitivity can predict cardiac toxicity in Anthracycline-based chemotherapy receiver. The use of strain with speckle echocardiography method has a prognostic value; however, both longitudinal and segmental strain should be assessed. Lateral and inferoseptal SLS (segmental longitudinal strain) are specific markers of cardiac toxicity in the course of anthracycline-related cardiac toxicity.

Keywords: Anthracyclines, cardiotoxicity, echocardiography, heart failure, biomarkers.

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(E-pub Ahead of Print)
DOI: 10.2174/1871529X19666190912150942

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