Cardiology Division, Pisa University Hospital, Pisa, Italy.
Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
Eur J Clin Invest. 2021 Apr;51(4):e13400. doi: 10.1111/eci.13400. Epub 2020 Sep 27.
Immune checkpoint inhibitors (ICIs) are an emerging option for several advanced metastatic cancers, but may have cardiotoxic effects. The prognostic value of high-sensitivity troponin T (hs-TnT) before treatment start has never been investigated.
Thirty consecutive patients underwent measurement of hs-TnT before starting ICI therapy (pembrolizumab, 23%; nivolumab, 12%; atezolizumab, 6%; durvalumab, 5%). The primary endpoint of cardiovascular death, stroke or transient ischaemic attack, pulmonary embolism and new-onset heart failure, and the secondary endpoint of progression of cardiac involvement according to the CARDIOTOX classification were evaluated after 3 months from the first cycle.
Patients (median age 68 years, 77% men, 13% with coronary artery disease, 90% current or former smokers, 67% overweight or obese and 43% hypertensive) had a median hs-TnT of 12 ng/L (interquartile interval 8-23). The primary endpoint occurred only in patients with hs-TnT ≥ 14 ng/L at baseline. Therefore, only patients who had hs-TnT ≥ 14 ng/L before the first cycle died had a stroke/TIA or new-onset HF. Furthermore, nine out of 13 patients with the secondary endpoint (progression of cardiac disease) had hs-TnT ≥ 14 ng/L before the first cycle (P = .012). AUC values were 0.909 for the primary endpoint and 0.757 for the secondary endpoint. The best cut-off was 14 ng/L for both the primary (100% sensitivity, 73% specificity) and secondary endpoints (sensitivity 75%, specificity 77%).
In patients on ICIs, baseline hs-TnT predicts a composite cardiovascular endpoint and the progression of cardiac involvement at 3 months, with 14 ng/L as the best cut-off.
免疫检查点抑制剂（ICIs）是几种晚期转移性癌症的新兴选择，但可能具有心脏毒性作用。在开始治疗前，高敏肌钙蛋白 T（hs-TnT）的预后价值从未被研究过。
连续 30 例患者在开始 ICI 治疗（帕博利珠单抗，23%；纳武利尤单抗，12%；阿替利珠单抗，6%；度伐利尤单抗，5%）前测量 hs-TnT。在第一个周期后 3 个月评估心血管死亡、中风或短暂性脑缺血发作、肺栓塞和新发心力衰竭的主要终点，以及根据 CARDIOTOX 分类评估心脏受累进展的次要终点。
患者（中位年龄 68 岁，77%为男性，13%有冠状动脉疾病，90%为当前或既往吸烟者，67%超重或肥胖，43%患有高血压）的 hs-TnT 中位数为 12ng/L（四分位距 8-23）。主要终点仅发生在基线 hs-TnT≥14ng/L 的患者中。因此，只有在第一个周期前 hs-TnT≥14ng/L 的患者才会发生中风/TIA 或新发心力衰竭。此外，有 9/13 例次要终点（心脏疾病进展）患者在第一个周期前 hs-TnT≥14ng/L（P=0.012）。主要终点和次要终点的 AUC 值分别为 0.909 和 0.757。最佳截断值为 14ng/L，用于主要终点（100%敏感性，73%特异性）和次要终点（敏感性 75%，特异性 77%）。
在接受 ICI 治疗的患者中，基线 hs-TnT 可预测 3 个月时的心血管复合终点和心脏受累进展，以 14ng/L 为最佳截断值。
