title: Are Biomarkers Predictive of Anthracycline-Induced Cardiac Dysfunction?
abstract: BACKGROUND
  The early detection of anthracycline- induced cardiotoxicity is very important since it might be useful in prevention of cardiac decompensation. This study was designed with the intent of assessing the usefulness of cardiac troponin T (cTnT) and NT- Pro BNP estimation in early prediction of anthracycline induced cardiotoxicity.
  
  
  METHODS
  In this prospective study histologically proven breast cancer patients who were scheduled to receive anthracycline containing combination chemotherapy as a part of multimodality treatment were enrolled. Baseline cardiac evaluation was performed by echocardiography (ECHO) and biomarkers like cardiac troponin T (cTnT) and N terminal- pro brain natriuretic peptide (NT- Pro BNP). All patients underwent cTnT and NT- Pro BNP estimation within 24 hours of each cycle of chemotherapy and were followed up after 6 months of initiation of chemotherapy. Any changes in follow up ECHO were compared to ECHO at baseline and cTnT and NT- Pro BNP levels after each cycle of anthracycline-based chemotherapy.
  
  
  RESULTS
  Initial data were obtained for 33 patients. Mean change in left ventricular diastolic diameter (LVDD) within 6 months was 0.154± 0 .433 cms (p value=0.049). Seven out of 33 patients had an increase in biomarker cTnT levels (p value=0.5). A significant change in baseline and follow up LVDD was observed in patients with raised cTnT levels (p value=0.026) whereas no change was seen in ejection fraction (EF) and left atrial diameters (LAD) within 6 months of chemotherapy. NT- Pro BNP levels increased in significant number of patients (p value ≤0.0001) but no statistically significant change was observed in the ECHO parameters within 6 months.
  
  
  CONCLUSIONS
  Functional monitoring is a poorly effective method in early estimation of anthracycline induced cardiac dysfunction. Estimation of biomarkers after chemotherapy may allow stratification of patients in various risk groups, thereby opening window for interventional strategies in order to prevent permanent damage to the myocardium.
authors.affiliation: Department of Radiation oncology, Dr B.R.A Institute of rotary cancer hospital, All India Institute of Medical Sciences , New Delhi, India E-mail : dr.abhidha@gmail.com.
authors.forename: Abhidha
authors.initials: A
authors.lastname: Malik
authors.forename: Pamela Alice
authors.initials: PA
authors.lastname: Jeyaraj
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Calton
authors.forename: Bharti
authors.initials: B
authors.lastname: Uppal
authors.forename: Preety
authors.initials: P
authors.lastname: Negi
authors.forename: Abhishek
authors.initials: A
authors.lastname: Shankar
authors.forename: Jaineet
authors.initials: J
authors.lastname: Patil
authors.forename: Manmohan Kishan
authors.initials: MK
authors.lastname: Mahajan
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D054715:Cardiotoxins / Q000009:adverse effects*; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009367:Neoplasm Staging; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*
chemical_list: D018943:Anthracyclines; D015415:Biomarkers; D054715:Cardiotoxins; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain