Hinrichs Lena, Mrotzek Simone Maria, Mincu Raluca-Ileana, Pohl Julia, Röll Alina, Michel Lars, Mahabadi Amir Abbas, Al-Rashid Fadi, Totzeck Matthias, Rassaf Tienush
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany.
Front Pharmacol. 2020 May 19;11:740. doi: 10.3389/fphar.2020.00740. eCollection 2020.
The long-term survival of cancer patients has significantly improved over the past years. Despite their therapeutic efficacy, various cancer therapies are associated with cardiotoxicity. Therefore, timely detection of cardiotoxic adverse events is crucial. However, the clinical assessment of myocardial damage caused by cancer therapy remains difficult.
This retrospective study was performed to evaluate the diagnostic value of cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for monitoring cancer therapy-induced cardiomyopathy. A total of 485 cancer patients referred to our cardio-oncology unit between July 2018 and January 2020 were selected from our (ECoR). We included patients with all types of cancer. Plasma concentrations of cTnI and NT-proBNP were measured by radioimmunoassay, and two-dimensional left ventricular ejection fraction (2D-LVEF), diastolic function, and global longitudinal strain (GLS) were measured by transthoracic echocardiography. In 116 patients, assessment was conducted before the induction of cancer therapy and during a short-term follow-up period; n = 42 of these were treated for malignant melanoma, and n = 42 with serial measurements were under treatment for breast cancer.
In cross-sectional data, elevated NT-proBNP was associated with reduced LVEF and pathological GLS in the total cohort. A total of 116 patients had serial LVEF and biomarker measurements, and changes in NT-proBNP and troponin correlated with changes in LVEF during follow-up investigations. Similar to the total cohort, a subgroup of patients treated for malignant melanoma showed a correlation between the change in cTnI and the change in LVEF. In a subgroup analysis of patients undergoing breast cancer therapy, a correlation between the change in NT-proBNP and the change in LVEF could be detected. Thirty patients presented with chemotherapy-induced cardiomyopathy, defined as a significant LVEF decrease (> 10%) to a value below 50%. The number of patients with increased cTnI and NT-proBNP was significantly higher in patients with chemotherapy-induced cardiomyopathy than in patients without cardiotoxicity. Patients with positive cTnI and NT-proBNP were more likely to have a history of coronary heart disease, atrial fibrillation, and arterial hypertension.
Our data suggest that cardiac biomarkers play an important role in the detection of cancer therapy-induced cardiotoxicity. Larger systematic assessment in prospective cohorts is mandatory.
在过去几年中，癌症患者的长期生存率有了显著提高。尽管各种癌症治疗方法具有治疗效果，但它们都与心脏毒性有关。因此，及时检测心脏毒性不良事件至关重要。然而，对癌症治疗引起的心肌损伤进行临床评估仍然困难。
本回顾性研究旨在评估心肌肌钙蛋白I（cTnI）和N末端B型利钠肽原（NT-proBNP）对监测癌症治疗引起的心肌病的诊断价值。从我们的（东部铁路公司）中选取了2018年7月至2020年1月期间转诊至我们心脏肿瘤科的485例癌症患者。我们纳入了所有类型癌症的患者。通过放射免疫测定法测量cTnI和NT-proBNP的血浆浓度，并通过经胸超声心动图测量二维左心室射血分数（2D-LVEF）、舒张功能和整体纵向应变（GLS）。在116例患者中，在开始癌症治疗前和短期随访期间进行了评估；其中42例接受恶性黑色素瘤治疗，42例接受乳腺癌治疗并进行了系列测量。
在横断面数据中，NT-proBNP升高与整个队列中的LVEF降低和病理性GLS相关。共有116例患者进行了系列LVEF和生物标志物测量，在随访研究期间，NT-proBNP和肌钙蛋白的变化与LVEF的变化相关。与整个队列相似，接受恶性黑色素瘤治疗的患者亚组显示cTnI变化与LVEF变化之间存在相关性。在接受乳腺癌治疗的患者亚组分析中，可以检测到NT-proBNP变化与LVEF变化之间的相关性。30例患者出现化疗引起的心肌病，定义为LVEF显著降低（>10%）至低于50%的值。化疗引起的心肌病患者中cTnI和NT-proBNP升高的患者数量显著高于无心脏毒性的患者。cTnI和NT-proBNP阳性的患者更有可能有冠心病、心房颤动和动脉高血压病史。
我们的数据表明，心脏生物标志物在检测癌症治疗引起的心脏毒性中起重要作用。在前瞻性队列中进行更大规模的系统评估是必要的。
