[Biochemical markers for predicting chemotherapy-induced cardiotoxicity: systematic review of the literature and recommendations for use].
Chemotherapy is a well established therapeutic approach for several malignancies, but its clinical efficacy is often limited by related cardiotoxicity leading to cardiomyopathy evolving towards heart failure that may worsen the patient outcome. To detect cardiac damage, the most frequently adopted diagnostic approach is the estimation of left ventricular ejection fraction by echocardiography, showing, however, low sensitivity in early prediction of cardiomyopathy, when appropriate treatments could still improve the patient's outcome. Cardiospecific biomarkers, like cardiac troponins, show high diagnostic efficacy in the early, subclinical phase of disease, becoming positive approximately 3 months before clinical onset of cardiomyopathy. Furthermore, the increase in their concentrations is well correlated with the disease severity and may predict the occurrence of major cardiac events during follow-up. On the other hand, negative troponin concentrations may identify patients with a very low risk of cardiomyopathy (negative predictive value = 99%). For cardiac natriuretic peptides, definitive evidence about a diagnostic or prognostic role in predicting chemotherapy-induced cardiomyopathy is lacking and their practical use in this context cannot be recommended until their clinical efficacy is clearly defined.
Dolci
Alberto
A
Laboratorio Analisi Chimico Cliniche, A.O. Luigi Sacco. a.dolci@hsacco.it
Dominici
Roberto
R
Cardinale
Daniela
D
Sandri
Maria Teresa
MT
Panteghini
Mauro
M
D015415:Biomarkers / Q000097:blood; D006331:Heart Diseases / Q000097:blood* / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood; D014336:Troponin / Q000097:blood
D015415:Biomarkers; D014336:Troponin; D020097:Natriuretic Peptide, Brain