Michel Lars, Rassaf Tienush, Totzeck Matthias
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany.
J Thorac Dis. 2018 Dec;10(Suppl 35):S4282-S4295. doi: 10.21037/jtd.2018.08.15.
Progress in cancer therapy over the past decades improved long-term survival but increased cancer therapy-related cardiotoxicity. Many novel treatment options have been implemented with yet incompletely characterized cardiovascular side effects including heart failure, coronary artery disease, arrhythmias, valvular disease, venous thromboembolism and myocarditis. Diagnosis of potential cardiotoxic side effects is essential for an optimal treatment but remains challenging. Cardiac biomarkers troponin and brain natriuretic peptide/N-terminal proBNP (BNP/NT-proBNP) have been extensively studied in heart failure and acute coronary syndromes. Emerging evidence implicates a significant role in the detection of cardiotoxicity and guidance of therapy in cancer patients. Elevated troponin or BNP/NT-proBNP levels were associated with increased all-cause mortality in cancer patients and have been shown to predict manifest heart failure. BNP/NT-proBNP may be useful for the prediction of cancer therapy-related heart failure and response to heart failure therapy in adult and pediatric cancer patients while troponin can indicate acute myocardial infarction in patients with cancer therapy-related risk for coronary artery disease. Furthermore, troponin may be used for the identification of immune checkpoint inhibitor-related myocarditis with very high sensitivity. Finally, even D-dimer levels have been shown to improve risk stratification and diagnosis in cancer-associated venous thromboembolism. This review aims to summarize the current knowledge about biomarkers in cancer therapy-related cardiotoxicity. We also outline possible clinical recommendations for the detection and treatment of subclinical and clinically apparent cardiotoxic effects using biomarkers.
在过去几十年中，癌症治疗取得了进展，提高了长期生存率，但增加了与癌症治疗相关的心脏毒性。许多新的治疗方案已经实施，但其心血管副作用尚未完全明确，包括心力衰竭、冠状动脉疾病、心律失常、瓣膜疾病、静脉血栓栓塞和心肌炎。潜在心脏毒性副作用的诊断对于优化治疗至关重要，但仍然具有挑战性。心脏生物标志物肌钙蛋白和脑钠肽/N末端前脑钠肽（BNP/NT-proBNP）已在心力衰竭和急性冠状动脉综合征中得到广泛研究。新出现的证据表明，它们在癌症患者心脏毒性的检测和治疗指导中发挥着重要作用。肌钙蛋白或BNP/NT-proBNP水平升高与癌症患者全因死亡率增加相关，并已被证明可预测明显的心力衰竭。BNP/NT-proBNP可能有助于预测成人和儿童癌症患者与癌症治疗相关的心力衰竭以及对心力衰竭治疗的反应，而肌钙蛋白可提示有癌症治疗相关冠状动脉疾病风险的患者发生急性心肌梗死。此外，肌钙蛋白可用于以非常高的敏感性识别免疫检查点抑制剂相关的心肌炎。最后，甚至D-二聚体水平也已被证明可改善癌症相关静脉血栓栓塞的风险分层和诊断。本综述旨在总结目前关于癌症治疗相关心脏毒性生物标志物的知识。我们还概述了使用生物标志物检测和治疗亚临床和临床明显心脏毒性作用的可能临床建议。
