title: Utility of high-sensitivity cardiac troponin T in patients receiving anthracycline chemotherapy.
abstract: BACKGROUND
  Anthracycline chemotherapy remains an integral part of the care for curative intent chemotherapy in breast cancer and non-Hodgkin lymphoma patients. Better tools need to be identified to predict cardiac complications of anthracycline chemotherapy.
  
  
  METHODS
  We investigated the utility of high-sensitivity cardiac troponin T (hscTnT), N-terminal pro-B-type natriuretic peptide, cardiac troponin T and I, and creatine kinase (CK)-MB in cancer patients receiving anthracycline-based chemotherapy, in order to determine whether baseline levels or changes in these biomarkers may help predict the onset of congestive heart failure.
  
  
  RESULTS
  Eighteen consecutive patients with a pathologic diagnosis of breast cancer or non-Hodgkin lymphoma were enrolled. The median dose of doxorubicin exposure was 240 mg/m(2) (range 240-400 mg/m(2)). After treatment with doxorubicin, the hscTnT increased to 19.1 pg/mL (P<0.001). CKMB and N-terminal pro-B-type natriuretic peptide levels increased to 1.1 ng/mL and 88.3 pg/mL, respectively (P=0.02). When subjects who had a decline in left ventricular ejection fraction (LVEF) by equilibrium radionuclide ventriculography were compared to those who did not have a change in LVEF, there was a suggestion that those subjects with an elevated baseline hscTnT were more likely to have a decline in LVEF (2.7 pg/mL and 0.1 pg/mL, respectively; P=0.07). Spearman correlation demonstrated that patients with higher baseline hscTnT and CKMB tended to have a greater decline in LVEF (Spearman correlation -0.54, 95% confidence interval -0.80 to -0.08 [P=0.02], and -0.49, 95% confidence interval -0.77 to -0.01 [P=0.04], respectively).
  
  
  CONCLUSIONS
  Elevations in baseline hscTnT levels are suggestive of an oncology subgroup at high risk of developing cardiac complications from their chemotherapy. Early detection by oncologists with the use of baseline biomarkers may be clinically important in designing interventions to prevent serious anthracycline-based chemotherapy complications.
authors.affiliation: Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Blaes
authors.affiliation: Division of Cardiology, University of Louisville, Louisville, KY, USA.
authors.forename: Aamer
authors.initials: A
authors.lastname: Rehman
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, USA ; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Vock
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, USA ; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA.
authors.forename: Xianghua
authors.initials: X
authors.lastname: Luo
authors.affiliation: Park Nicollet Frauenshuh Cancer Center, St Louis Park, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Menge
authors.affiliation: Masonic Cancer Center, University of Minnesota, Minneapolis, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Yee
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Emil
authors.initials: E
authors.lastname: Missov
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Duprez
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000188:drug therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004317:Doxorubicin / Q000009:adverse effects*; D042241:Early Diagnosis; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000903:Antibiotics, Antineoplastic; D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004317:Doxorubicin; D052279:Creatine Kinase, MB Form
keywords: cardiomyopathy; chemotherapy; doxorubicin; troponin T