Gansu University of Chinese Medicine, Lanzhou, 730000, China.
Key Laboratory of Prevention and Treatment for Chronic Diseases by Traditional Chinese Medicine, University Hospital of Gansu Traditional Chinese Medicine, Lanzhou, China.
ESC Heart Fail. 2023 Aug;10(4):2170-2182. doi: 10.1002/ehf2.14373. Epub 2023 May 11.
Early diagnosis of cancer treatment-related cardiac dysfunction (CTRCD) is important as cancer therapy increases the risk of cardiac dysfunction. High-sensitivity cardiac troponin T (hs-cTnT) is a highly specific marker of myocardial injury. However, its diagnostic value for CTRCD has not been systematically evaluated. This meta-analysis aimed to evaluate whether hs-cTnT could be used as an early diagnostic biomarker for CTRCD. We systematically surveyed PubMed, Embase, Cochrane Library, and Web of Science databases for studies of hs-cTnT for the diagnosis of CTRCD before 1 April 2022. Patients of all ages and all cancer types who underwent echocardiographic left ventricular ejection fraction assessment and blood hs-cTnT and received anticancer therapy (including chemotherapy, radiotherapy, targeted therapy, immune checkpoint inhibitors, and other treatments) were included in this study, resulting in a total of eight studies with 1294 patients. The occurrence of CTRCD was associated with elevated hs-cTnT [sensitivity: 0.78, 95% confidence interval (CI): 0.64-0.88; specificity: 0.75, 95% CI: 0.59-0.86; area under the curve (AUC): 0.83, 95% CI: 0.80-0.86]. We further performed subgroup analysis and found that the AUC of hs-cTnT elevation for the diagnosis of CTRCD increased from 0.83 to 0.90 (95% CI: 0.87-0.92) at 3-6 months, suggesting a higher early diagnostic value of hs-cTnT compared with echocardiography for CTRCD. In terms of clinical applicability, the Fagan plot showed pre-test and post-test probabilities of 51% and 9%, respectively, indicating that hs-cTnT testing can improve the accuracy of clinical diagnosis of CTRCD. However, it was not possible to determine the optimal cut-off value for early diagnosis of CTRCD with hs-cTnT. The Deeks funnel plot was largely symmetrical (P = 0.74); hence, publication bias was not observed. Hs-cTnT allowed early CTRCD diagnosis at 3-6 months. However, further high-quality research is needed to determine the optimal cut-off value for early CTRCD diagnosis with this biomarker.
癌症治疗相关心功能障碍（CTRCD）的早期诊断很重要，因为癌症治疗会增加心功能障碍的风险。高敏心肌肌钙蛋白 T（hs-cTnT）是心肌损伤的高度特异性标志物。然而，其对 CTRCD 的诊断价值尚未得到系统评价。这项荟萃分析旨在评估 hs-cTnT 是否可作为 CTRCD 的早期诊断生物标志物。我们系统地检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库，以获取 2022 年 4 月 1 日前关于 hs-cTnT 诊断 CTRCD 的研究。纳入研究对象为接受超声心动图左心室射血分数评估和血液 hs-cTnT 检测且接受抗癌治疗（包括化疗、放疗、靶向治疗、免疫检查点抑制剂和其他治疗）的所有年龄段和所有癌症类型的患者，共纳入 8 项研究，总计 1294 例患者。CTRCD 的发生与 hs-cTnT 升高相关[敏感度：0.78，95%置信区间（CI）：0.64-0.88；特异度：0.75，95% CI：0.59-0.86；曲线下面积（AUC）：0.83，95% CI：0.80-0.86]。我们进一步进行了亚组分析，发现 hs-cTnT 升高对 CTRCD 的诊断 AUC 从 3-6 个月时的 0.83 增加到 0.90（95% CI：0.87-0.92），提示 hs-cTnT 对 CTRCD 的早期诊断价值高于超声心动图。在临床适用性方面，Fagan 图显示，hs-cTnT 检测的预试验和后试验概率分别为 51%和 9%，表明 hs-cTnT 检测可提高 CTRCD 临床诊断的准确性。但是，无法确定 hs-cTnT 用于早期诊断 CTRCD 的最佳截断值。Deeks 漏斗图大体对称（P=0.74）；因此，未观察到发表偏倚。hs-cTnT 可在 3-6 个月时早期诊断 CTRCD。然而，需要进一步开展高质量研究来确定该生物标志物早期诊断 CTRCD 的最佳截断值。
