According to research presented during the 21st annual scientific sessions of the American Society of Echocardiography (ASE) in San Diego this week, cardiac troponin plasma concentrations and longitudinal strain can predict the development of cardiotoxicity in patients treated with anthracyclines and trastuzumab chemotherapies.
The study investigators, led by Heloisa Sawaya, MD, PhD, from Massachusetts General Hospital and Harvard Medical School in Boston, sought to evaluate if more sensitive echocardiographic measurements and biomarkers could predict future cardiac dysfunction in patients treated with chemotherapy. “As breast cancer survival increases, cardiotoxicity is becoming a more serious issue, as it may result in death,” said Sawaya, noting that left ventricular ejection fraction (LVEF) can fail to detect subtle alterations in LV function.
The researchers recruited 43 breast cancer patients being treated with anthracyclines and trastuzumab. Each patient underwent blood sampling and an echocardiogram at baseline and at three and six months over the course of chemotherapy treatment.
Sawaya and colleagues measured left ventricular ejection fraction, peak systolic myocardial longitudinal and radial strain, as well as N-terminal pro B type natriuretic peptide and high sensitivity cardiac troponin.
Of the 43 patients, nine (21 percent) were determined to have developed cardiotoxicity. Of these nine patients, the researchers established that one had developed cardiotoxicity (as defined by the Cardiac Review and Evaluation Committee reviewing trastuzumab) at three months into therapy, while the other eight developed it by the six-month follow up.
However, the authors wrote that left ventricular ejection fraction and N-terminal pro B type natriuretic peptide was not found to be a predictor of cardiotoxicity. “A decrease in longitudinal strain from baseline to three months and a detectable high sensitivity cardiac troponin at three months were independent predictors of the development of cardiotoxicity at six months,” they wrote.
In addition, the patients had a three percent probability of decreasing their left ventricular ejection fraction three months after the evaluation if they saw a decrease of more than 10 percent in their peak systolic longitudinal strain or an elevation in high sensitivity cardiac troponin. In these patients compared to those who had no changes in either of these markers, a nine-fold increase in risk of cardiotoxicity was noted by the researchers.
Both cardiac troponin plasma concentrations and longitudinal strain “may be useful to detect chemotherapy-treated patients who may benefit from alternative therapies,” said Sawaya, who concluded that by offering alternative therapies to patients, the incidence of morbidity and mortality associated with cardiotoxicity could potentially be decreased.