title: High-sensitive cardiac troponin-I facilitates timely detection of subclinical anthracycline-mediated cardiac injury.
abstract: Background Anthracycline drugs are effective anticancer agents, but their optimal use is limited in many patients by the associated cardiotoxicity, even at designated safe doses. As conventionally sensitive cardiac troponin-I assays fail to reliably quantify concentrations of cardiac troponin-I below 30 ng/L, we investigated the potential role of high-sensitive cardiac troponin-I in the detection of subclinical cardiomyocyte injury in patients treated with anthracycline agents. Methods Serial high-sensitive cardiac troponin-I concentrations were assessed in 84 patients, receiving anthracycline-containing ( n = 38) and non-anthracycline-containing ( n = 46) regimens. Results were assessed for change from pretreatment levels and evaluated according to unisex and gender-specific 99th percentiles (25 ng/L and M: 34 ng/L, F: 16 ng/L, respectively). Results A significant increase in high-sensitive cardiac troponin-I was observed in the anthracycline cohort following five cycles of treatment, with the greatest change correlating to an absolute δ increase of 30.7 ng/L in the early-dose group (early-dose group: P < 0.0001, late-dose group: P < 0.01 and continuous-dose group: P < 0.0001). Doxorubicin dose did not correlate directly with high-sensitive cardiac troponin-I concentrations (Spearman r < -0.22). No significant changes in high-sensitive cardiac troponin-I were reported among the non-anthracycline cohort with all measurements below the 99th percentiles. Conclusions Treatment with anthracycline-based chemotherapeutic regimen demonstrated significant elevations of high-sensitive cardiac troponin-I, indicative of subclinical cardiomyocyte damage. This study demonstrates a role for high-sensitive cardiac troponin-I in evaluating those patients where cardiotoxicity is a concern and a potential future role as a biomarker in optimizing cardioprotective treatments in patients receiving anthracycline therapy.
authors.affiliation: 1 Department of Clinical Chemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jones
authors.affiliation: 2 Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Gorman
authors.affiliation: 3 Department of Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kelly
authors.affiliation: 4 Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Niall
authors.initials: N
authors.lastname: Mahon
authors.affiliation: 1 Department of Clinical Chemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Fitzgibbon
mesh_terms: D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D009202:Cardiomyopathies / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology; D004317:Doxorubicin / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D032383:Myocytes, Cardiac / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D015415:Biomarkers; D019210:Troponin I; D004317:Doxorubicin
keywords: Troponin; anthracycline; chemotherapy; monitoring; myocyte