Cardiotoxicity and cancer therapy: treatment-related cardiac morbidity in patients presenting with symptoms suggestive of heart or lung disease.
OBJECTIVE
Cardiac injury is one of the complications of cancer treatment. This study aimed to investigate the relationships between the types of radiotherapy of the chest (RT), chemotherapy (CT), cancer surgery (CS) and endocrine therapy (ET), and the presence of heart disease, and their associations with the serum level of N-terminal pro-B-type natriuretic peptide (NT-proBNP).


METHODS
A consecutive series of 374 patients with cancer who were referred because of symptoms suggestive of heart or lung disease prospectively underwent a diagnostic workup.


RESULTS
The prevalence of heart disease was 36.9%. RT administered before 1995 (n = 19) was associated with both increased odds of heart disease [adjusted odds ratio 10.3, 95% confidence interval 3.1-34.0] and higher ln-transformed NT-proBNP values (p < 0.01) compared to the control group (no RT or RT for right-sided breast cancer from 1995 onwards; n = 311). Anthracycline-treated patients (n = 54) had higher adjusted values for ln(NT-proBNP) compared to the control group (no CT; n = 243; p < 0.01) but no increased odds of heart disease.


CONCLUSIONS
While pre-1995 RT and anthracycline-containing CT were associated with cardiac effects, there was no evidence that RT using modern cardioprotective techniques, CT in the absence of anthracyclines, CS or ET had detrimental effects on the heart.
Department of Cardiology, Pulmonology and Critical Care Medicine, Offenburg Hospital, Offenburg, Germany.
Siegfried
S
Wieshammer
Jens
J
Dreyhaupt
Dirk
D
Müller
Felix
F
Momm
Andreas
A
Jakob
Ulrich
U
Freund
D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006331:Heart Diseases / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D006352:Heart Ventricles / Q000187:drug effects*; D006801:Humans; D008171:Lung Diseases / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D016017:Odds Ratio; D058958:Organs at Risk; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D020107:Troponin T / Q000097:blood
D018943:Anthracyclines; D000970:Antineoplastic Agents; D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain