High-Sensitivity Troponin T as a Prognostic Factor of Conventional Echocardiographic Parameters in Cancer Patients: A Prospective Observational Study.

Background and

Objectives

Cardiac injury caused by cancer therapy can be detected early using high-sensitivity cardiac troponins (hs-cTns), and this is crucial for preventing irreversible consequences. Clinically relevant issues regarding hs-cTns in oncologic settings-such as reliable cut-off values, the optimal assessment timeframe, factors influencing their levels, and their prognostic ability in relation to functional echocardiographic parameters-require further investigation. In this study, we aimed to examine the determinants of hs-cTnT variations during cancer therapy and the relationship between the biomarker and functional conventional echocardiographic parameters. Materials and

Methods

We prospectively evaluated adult patients scheduled for chemotherapy for either breast or gastrointestinal cancers, excluding those with pulmonary and cardiac disorders. We enrolled 40 patients who underwent a minimum of one cycle of potentially cardiotoxic regimens containing at least one of the following agents: anthracyclines, cyclophosphamide, taxanes, 5-fluorouracil, platinum compounds, trastuzumab, or bevacizumab. We observed two-dimensional and tissue Doppler echocardiographic parameters and hs-cTnT levels for a median of 360 days (IQR 162, 478) following the start of chemotherapy.

Results

The generalised estimating equation (GEE) analysis revealed significant elevations in hs-cTnT levels at three months (β = 1.2; p = 0.005) and six months (β = 2.3; p = 0.02) from baseline, influenced by anthracycline treatment (p = 0.009), renal function (p = 0.003), and increased cardiotoxicity risk (high: p = 0.013; medium: p < 0.001). Elevated hs-cTnT levels independently predicted the deterioration of the LV longitudinal myocardial function, measured by the systolic tissue velocities, according to the GEE analysis. The receiver operating characteristic curve-derived hs-cTnT thresholds-of 8.23 ng/L and 8.08 ng/L-had a high negative predictive value for identifying Average and Lateral LVS' decreases, respectively.

Conclusions

Our research supports the use of baseline and continuing hs-cTnT testing in cancer patients, showing the dependence of the biomarker on renal function, cardiovascular toxicity risk level, and anthracycline treatment. The hs-cTnT cut-off value of approximately 8 ng/L may suggest a low probability of longitudinal myocardial function impairment and this observation needs further validation in larger cohorts.