Title:Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity
VOLUME: 20 ISSUE: 1
Author(s):Mohammad P. Mahjoob, Seyed A. Sheikholeslami, Morvarid Dadras, Hamdollah Mansouri, Mahshid Haghi, Mohammadreza Naderian, Leila Sadeghi, Mohammadreza Tabary* and Isa Khaheshi*
Affiliation:Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Fellowship of Echocardiography, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Department of Medical Nanotechnology, Faculty of Advanced Sciences & Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Cardiovascular Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Imam Hossein Hospital, Internal Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, School of Medicine, Tehran University of Medical Sciences, Tehran, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran
Keywords:Anthracyclines, cardiotoxicity, echocardiography, heart failure, biomarkers, cardiovascular diseases.
Abstract:
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.
Methods: 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.
Results: 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 be 0.968.
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, hscTnI
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.
