Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan,
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Oncology. 2020;98(9):653-660. doi: 10.1159/000507585. Epub 2020 May 26.
Anthracycline is used to treat various types of cancer; however, cardiotoxicity negatively affects patient prognosis.
The aim of the present study was to investigate serial changes in levels of cardiac troponin I (TnI) and B-type natriuretic peptide (BNP) in patients treated with anthracycline-containing therapy.
91 consecutive cancer patients planned for anthracycline treatment were enrolled and followed up for 12 months. All patients underwent echocardiography and blood sampling at baseline, 3, 6, and 12 months.
The patients were divided into two groups based on their TnI level during the follow-up period: the elevated TnI group (TnI ≥0.03 ng/mL; n = 37) and the normal TnI group (n = 54). In the elevated TnI group, the TnI levels increased at 3 and 6 months, but they returned to within normal range at 12 months after anthracycline administration. Unlike TnI, the BNP levels began to increase after 6 months, and remained increased at 12 months. The occurrence of cancer therapeutics-related cardiac dysfunction was higher in the elevated TnI group than in the normal TnI group. When we set the cut-off value of TnI at 0.029 ng/mL, sensitivity and specificity to predict an elevated BNP level of more than 100 pg/mL were 90 and 63%, respectively. Multivariate logistic regression analysis revealed that elevated TnI was an independent predictor of elevated BNP levels.
Elevated TnI was an independent predictor for the development of BNP increase. The different characteristics of TnI and BNP should be considered when managing patients treated with anthracycline-containing therapy.
蒽环类药物用于治疗多种类型的癌症，但心脏毒性会对患者预后产生负面影响。
本研究旨在探讨接受含蒽环类药物治疗的患者中心肌肌钙蛋白 I（TnI）和 B 型利钠肽（BNP）水平的连续变化。
纳入 91 例计划接受蒽环类药物治疗的连续癌症患者，并进行 12 个月的随访。所有患者在基线、3、6 和 12 个月时进行超声心动图和血液采样。
根据随访期间 TnI 水平，患者分为两组：TnI 升高组（TnI≥0.03ng/mL；n=37）和 TnI 正常组（n=54）。在 TnI 升高组中，TnI 水平在 3 个月和 6 个月时升高，但在蒽环类药物给药后 12 个月恢复正常。与 TnI 不同，BNP 水平在 6 个月后开始升高，并在 12 个月时仍升高。在 TnI 升高组中，癌症治疗相关心脏功能障碍的发生率高于 TnI 正常组。当我们将 TnI 的截断值设定为 0.029ng/mL 时，预测 BNP 水平升高超过 100pg/mL 的 TnI 的灵敏度和特异性分别为 90%和 63%。多变量逻辑回归分析显示，TnI 升高是 BNP 升高的独立预测因子。
TnI 升高是 BNP 升高的独立预测因子。在管理接受含蒽环类药物治疗的患者时，应考虑 TnI 和 BNP 的不同特征。
