Cardiac biomarkers indicate a need for sensitive cardiac imaging among long-term childhood cancer survivors exposed to anthracyclines.
OBJECTIVE
The role that plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponins T (cTnT) and I (cTnI) play in supplementing imaging to screen for cardiac late effects remains controversial and the impact of high-sensitivity cTnT and troponin-specific autoantibodies (cTnAAbs) remains unexplored. We studied the role of cardiac biomarkers as indicators of the late effects of anthracyclines among childhood cancer survivors.


METHODS
We measured NT-proBNP, cTnT, high-sensitivity cTnT, cTnI and cTnAAbs in 76 childhood cancer survivors at a median of 9 years after primary diagnosis. The survivors underwent conventional and real-time three-dimensional echocardiography and 62 underwent cardiac magnetic resonance imaging (MRI).


RESULTS
Of the survivors, four (5.3%) without risk factors for cardiotoxicity were cTnAAb-positive with an impaired cardiac function in MRI. Another four (5.3%) had an abnormal NT-proBNP level associated with an abnormal cardiac function and risk factors for cardiotoxicity. None showed measurable cardiac troponins, determined by the three different methods, with even the high-sensitivity cTnT-levels remaining normal.


CONCLUSIONS
Elevated plasma NT-proBNP or cTnAAbs indicated that childhood cancer survivors benefitted from being evaluated with modern imaging, despite normal function in conventional echocardiography. However, troponins did not seem to provide additional information on the late cardiotoxicity of anthracyclines.
Department of Paediatrics, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland.
Kaisa
K
Ylänen
Tuija
T
Poutanen
Tanja
T
Savukoski
Anneli
A
Eerola
Kim
K
Vettenranta
D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D009202:Cardiomyopathies / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D002648:Child; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009369:Neoplasms / Q000188:drug therapy*; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017741:Survivors; D019210:Troponin I / Q000097:blood / Q000276:immunology; D020107:Troponin T / Q000097:blood / Q000276:immunology; D055815:Young Adult
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D001323:Autoantibodies; D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
Autoantibodies to cardiac troponin; Cardiac function; Malignancy; Natriuretic peptide; Troponin