Evaluation of Cardiac Biomarkers in Detection of Cardiomyopathy Induced by Cardiotoxic Chemotherapeutic Agents

Background: Doxorubicin is a potent chemotherapeutic drug. The clinical usefulness of doxorubicin has been limited largely by the risk of cardiomyopathy and life-threatening heart failure. Therefore early identification of cardiotoxicity represents a primary goal for cardiologist and oncologist, considering the definition of personalized anticancer therapeutic strategies or intervention. The use of endomyocardial biopsy for detection of myocardial damage and monitoring of cardiac functions is troublesome in clinical practice.

Aim: So, evaluation of different cardiac biomarkers was performed to specifically detect myocardial injury and to predict ventricular dysfunction.

Methods: Fifty two adult AL patients (mean age 48.9±11.8 years, 25 males) treated with 2–6 cycles of chemotherapy (CT) containing cardiotoxic chemotherapeutic drugs were studied. Cardiac evaluation was performed at baseline, after first and last chemotherapy with cardiotoxic drugs and 6 months after chemotherapy.

Results: Mean baseline NT-proBNP (N-terminal pro brain natriuretic peptide) concentration was 109.3±42.7 pg/ml (slightly elevated in 6 patients). After first and last chemotherapy, NT-proBNP elevations to 317.8±147.6 pg/ml and 302.3±123.9 pg/ml were observed, respectively. Six months after CT, mean NT-proBNP concentration was 412.5±184.2 pg/ml (elevated in 32 patients). Changes in NT-proBNP were significant in comparison with the baseline values (p < 0.001). Six months after chemotherapy, four patients with marked NT-proBNP elevations during chemotherapy developed treatment-related cardiomyopathy with symptoms of heart failure. NT-proBNP correlated with systolic and diastolic LV dysfunction on echocardiography (r = 0.638; p < 0.01) and (r = 0.412; p < 0.01). hs-cTnT concentrations were negative (<10 pg/ml) during chemotherapy in all patients. Six months after chemotherapy, delayed hs-cTnT positivity occurred in 6 patients. CK-MB mass remained within the reference range in all patients.

Conclusion: The present study suggests that NT-proBNP in blood is better indicator for the detection of doxorubicin induced cardiotoxicity during the treatment and the follow-up than hs-cTnT, cTnI and CK-MB.