Jun 2026· International Journal of Cancer· 0 citations· 32 references
Medicine
TL;DR
Cardiotoxicity levels in cTnT and NT-proBNP levels increase significantly during treatment and can be valuable markers to improve the risk stratification of patients treated with high-dose anthracyclines and can be valuable markers to improve the risk stratification of patients treated with high-dose anthracyclines.
Abstract
Treatment of sarcoma includes high-dose anthracyclines, which can cause cardiotoxicity. This study assesses the correlation of cardiac biomarkers and echocardiographic parameters on asymptomatic cardiotoxicity in sarcoma patients treated with anthracyclines. Consecutive patients diagnosed with sarcoma and treated with anthracyclines were included in this retrospective cohort study using registry data. Echocardiography was performed before start of anthracycline chemotherapy (baseline), after completing treatment (short-term follow-up), and 6-12 months after termination of treatment (long-term follow-up). The primary endpoint was the occurrence of asymptomatic cardiotoxicity at short-term follow-up. We included 44 patients (29.6% female) with a median age of 28.9 [22.2-38.7] years. Baseline left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) decreased significantly from 58.4% ± 5.0% to 54.2% ± 9.3% (p = 0.013) and -19.1% ± 2.2% to -17.2% ± 3.5% at short-term follow-up (p = 0.002), respectively. After Cycle 1, 86.5% of the patients showed NT-proBNP ≥ 125 ng/L compared to 3.9% at baseline (p < 0.001), and after completion of therapy, 65.5% had elevated cardiac Troponin T (cTnT) ≥ 14 ng/L compared to 11.5% at baseline (p = 0.003). Asymptomatic cardiotoxicity was observed in 30 patients (68.2%). Mean follow-up was 2.4 [1.5-2.9] years. cTnT ≥ 14 ng/L after Cycle 4 was associated with cardiotoxicity (HR: 3.75 [1.28-11.0], p = 0.016), and NT-proBNP per 100 units increase after Cycle 1 was associated with an increased risk of mortality (HR: 1.36 [1.004-1.85], p = 0.047). Sarcoma patients treated with high-dose anthracyclines are at increased risk of developing cardiac dysfunction as assessed by LVEF and GLS. cTnT and NT-proBNP levels increase significantly during treatment and can be valuable markers to improve the risk stratification of patients treated with high-dose anthracyclines.
It is suggested that survivors treated with anthracyclines require systematic surveillance and targeted interventions to address modifiable cardiovascular risk factors and increasing awareness of prior cardiotoxic cancer treatment among survivors and health care providers may facilitate cardiovascular risk reduction.
Vigdís H Viggósdóttir, H. Helgason, Helga Jónsdóttir et al.· Journal of pediatric hematol...· 0 citations
Anthracyclines remain a cornerstone of breast cancer therapy but carry a significant risk of cancer therapy-related cardiac dysfunction (CTRCD). This study evaluates the incidence of CTRCD in an Indonesian setting using the latest 2022 ESC Cardio-Oncology guidelines, focusing on subclinical markers such as high-sensitivity Troponin I (hs-cTnI), Global Longitudinal Strain (GLS) and Mechanical Dispersion (MD).
This retrospective analytical cohort study involved 98 breast cancer patients treated with anthracyclines at a national referral hospital in Indonesia from July 2018 to February 2020. Clinical assessments, hs-cTnI, and echocardiography (LVEF, GLS, and MD) were performed at baseline, 1, 3, and 6 months. CTRCD was defined per the 2022 ESC criteria.
CTRCD occurred in 74.5% of patients, predominantly as asymptomatic mild cases (63.26%). While symptomatic CTRCD was relatively low (7.14%), asymptomatic dysfunction was detected as early as one-month post-chemotherapy. A significant progressive decline was observed in LVEF (68.2 ± 6.2% to 61.3 ± 8.8%,
p
< 0.001) and GLS (-19.7 ± 2.9% to -17.1 ± 3.5%,
p
< 0.001). Notably, mechanical dispersion significantly increased over time (
p
= 0.029), and median hs-cTnI surged from 1.6 ng/L to 82.2 ng/L (
p
< 0.001) by month 6.
The high incidence of asymptomatic CTRCD underscores the inadequacy of relying on clinical symptoms alone. Integration of hs-cTnI, GLS, and mechanical dispersion monitoring is may be essential for early detection and enables timely cardioprotective intervention.
GLS and LVEF were the most sensitive echocardiographic parameters for differentiating between groups with and without cardiotoxicity, showing consistent changes throughout the study.
R. D. De Sousa, V. Fonseca, M. Henriques et al.· European Heart Journal, Supp...· 0 citations
A simplified risk score based on readily available clinical and echocardiographic variables for predicting anthracycline-related cardiotoxicity and the RE-ACT score provides additional post-treatment prognostic value is developed and validated and supports a practical 2-step strategy for personalized surveillance in cardio-oncology.
D. Cardinale, Nicola Cosentino, Chiara Morocutti et al.· JACC CardioOncology· 1 citation
Anthracyclines (ANTs) are important chemotherapeutic drugs for the treatment of lymphoma. However, its cardiotoxicity poses a challenge to its continued use. The development of ARCD is influenced by multiple factors, making early detection challenging. Three-dimensional speckle tracking imaging (3D-STI) can quantitatively analyze myocardial strain by tracking the movement of myocardial spots. This study compared the parameters derived from conventional echocardiography, 3D-STI, and three-dimensional echocardiography at baseline (T0), 2 cycles of chemotherapy (T2) and 4 cycles of chemotherapy (T4), and analyzed the risk factors for ARCD. From January 2020 to December 2024, a total of 189 patients with non-Hodgkin lymphoma were recruited, all of whom received at least 4 cycles of ANT treatment. During chemotherapy and follow-up, 28 patients developed ARCD. Firth-penalized logistic regression demonstrated that age ≥65 years (aOR = 3.416, 95% CI: 1.241-9.913), hypertension (aOR = 3.051, 95% CI: 1.095-8.675), and cumulative ANT dose (aOR = 1.028, 95% CI: 1.017-1.040) were independently associated with an increased risk of ARCD. Conventional echocardiographic parameters, including LVEF, showed no significant changes. Compared with T0, right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) were significantly increased at T4 (P<0.05), left ventricular global longitudinal strain (LVGLS) was significantly decreased at T2 (P<0.05), and left ventricular global circumferential strain (LVGCS) was significantly decreased at T4 (P<0.05). The absolute change in LVGLS from T0 to T2 (ΔLVGLS) was significantly and positively correlated with the cumulative ANT dose (R = 0.336, P<0.001). The cut-off value for predicting ARCD using ΔLVGLS was 3.5%. The area under the curve (AUC) was 0.852 and the respective sensitivity and specificity were 0.929 and 0.739. 3D-STI, particularly LVGLS, demonstrated significant value in the early identification of cardiac dysfunction in patients with lymphoma undergoing ANT treatment.
Jing Jiang, Xiaole Mu, Xiaomei Chen et al.· American Journal of Cancer R...· 0 citations
Cardiotoxicity associated with antineoplastic therapies remains an important clinical challenge in modern oncology. Early identification of subclinical cardiac injury may improve cardiovascular surveillance and long-term outcomes in cancer patients. This prospective observational cohort study included 90 adult patients with breast cancer, lymphoma, or lung cancer receiving potentially cardiotoxic therapy. Patients with clinically manifest heart failure, severe arrhythmias, advanced renal disease, recent acute myocardial infarction, untreated severe valvular disease, or other major cardiovascular comorbidities were excluded. High-sensitivity cardiac troponin T (hs-cTnT), NT-proBNP, and soluble ST2 (sST2) were measured at baseline, during treatment, at therapy completion, and at late follow-up. Non-parametric tests were used for repeated-measures and subgroup comparisons. Significant temporal variations were observed for all biomarkers. hs-cTnT increased from 5 [3–8] ng/L at baseline to 15 [10–25] ng/L at T2, while NT-proBNP increased from 120 [80–190] pg/mL to 210 [150–320] pg/mL. sST2 demonstrated a delayed elevation and remained increased at follow-up. Distinct biomarker patterns were observed across malignancy subgroups, with higher hs-cTnT increases in breast cancer, more prominent NT-proBNP elevation in lymphoma, and higher sST2 values in lung cancer. Serial biomarker assessment may provide complementary information on myocardial injury, ventricular stress, and fibrotic remodeling during cancer therapy. The observed biomarker trajectories are suggestive of different biological processes involved in therapy-related cardiotoxicity, but they should be interpreted in conjunction with imaging findings and clinical outcomes.
L. Kajanto, D. Stănculeanu, Anca Chisoi et al.· Cardio-Oncology· 0 citations
