Optimizing cardiotoxicity monitoring protocols: less but not worst
López Fernández, Teresa1; Álvarez Ortega, Carlos1; Rodriguez Fraga, Olaia2; GonzálezFernandez, Oscar1; Valbuena López, Silvia1; Moreno Yangüela, Mar1; Buño Soto,
Antonio2; Batlle Feliu Jaime3; Canales Albendea Miguel4; López- Sendón, José Luis1.
1Cardiology
Department, 2Clinical Laboratory Department, 3Oncology Department,
4Hematology Department. Cardio-Oncology Unit. University Hospital La Paz, IdiPaz
Research Institute, Madrid, Spain
Introduction
Advances in the diagnosis and treatment of cancer have markedly decrease cancerrelated mortality, whereas long term survivors experience a significant increase in
cardiovascular events. Previous investigations support the need for an early diagnosis
and treatment of cancer induced left ventricular dysfunction (LVD). However, the
complexity of standard monitoring protocols precludes their application in daily
practice. Cardiac biomarkers have been proposed as diagnostic and prognostic tools
for LVD. The aim of this study is to evaluate whether cardiac biomarker can simplify CV
monitoring in daily cancer patients.
Methods
Patients from CARDIOTOX registry. Baseline transthoracic echocardiography (TTE) and
cardiac biomarkers were performed at 1, 3, 6, 12, 18 and 24 months follow-up (F/U).
Cardiotoxicity (CT) was defined as a decrease in left ventricular ejection fraction (LVEF)
>10% from the basal to <53%. Hs-cTnT (Roche Elecsys hs-cTnT (14 ng/L CV= 10%), c-TnI
Siemens Vista c-TnI (27 ng/L CV= 7,7%)and NT-proBNP (125 (<75 years) and 450 pg/mL
(>75 years)were measured.
Results
348 patients were included, mean age 55.9±14.8 years, 83% women. Tumor location
was: 68.9% breast cancer, 20.4% leukemia or lymphoma and 10.6% others. Mean basal
LVEF was 63,5±6.6%. The cumulative incidence of CT at 1 year was 10,4 %. During F/U
35 % of patients with hs-TnT above p99 developed CT. Maximum concentration of hscTnT level above p99 occurred at third month. Sensitivity of hs-cTnT at 3-month for CT
prediction at 12 month F/U was 74%, with a specificity of 49% and NPV of 93%. The
NPV increases if we use hs-cTnT and BNP as markers of LVD in each visit. If these
markers are negative, the immediate risk of LVD is very low. This finding let us
optimize the numbers of echo studies needed for CT monitoring (figure1)
Conclusions
Hs-cTnT at three month after starting a potentially cardiotoxic drug regime has a high
NPV and can play a role in early detection of LVD. The NPV increases if we use Hs-cTnT
and NT-proBNP for LVD diagnosis during CT monitoring