Dynamic changes in high-sensitivity cardiac troponin I in response to anthracycline-based chemotherapy

Tzolos, E. et al. (2020) Dynamic changes in high-sensitivity cardiac troponin I in response to anthracycline-based chemotherapy. Clinical Oncology, 32(5), pp. 292-297. (doi: 10.1016/j.clon.2019.11.008) (PMID:31813662) (PMCID:PMC7139216)

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Abstract

Aims: Treatment advances have improved cancer-related outcomes and shifted interest towards minimising long-term iatrogenic complications, particularly chemotherapy-related cardiotoxicity. High-sensitivity cardiac troponin I (hs-cTnI) assays accurately quantify very low concentrations of plasma troponin and enable early detection of cardiomyocyte injury prior to the development of myocardial dysfunction. The profile of hs-cTnI in response to anthracycline-based treatment has not previously been described. Materials and methods: This was a multicentre prospective observational cohort study. Female patients with newly diagnosed invasive breast cancer scheduled to receive anthracycline-based (epirubicin) chemotherapy were recruited. Blood sampling was carried out before and 24 h after each cycle. Hs-cTnI concentrations were measured using the Abbott ARCHITECTSTAT assay. Results: We recruited 78 women with a median (interquartile range) age of 52 (49–61) years. The median baseline troponin concentration was 1 (1–4) ng/l and the median cumulative epirubicin dose was 394 (300–405) mg/m2. Following an initial 33% fall 24 h after anthracycline dosing (P < 0.001), hs-cTnI concentrations increased by a median of 50% (P < 0.001) with each successive treatment cycle. In total, 45 patients had troponin measured immediately before the sixth treatment cycle, 21 (46.6%) of whom had hs-cTnI concentrations ≥16 ng/l, indicating myocardial injury. Plasma hs-cTnI concentrations before the second treatment cycle were a strong predictor of subsequent myocardial injury. Conclusions: Cardiotoxicity arising from anthracycline therapy is detectable in the earliest stages of breast cancer treatment and is cumulative with each treatment cycle. This injury is most reliably determined from blood sampling carried out before rather than after each treatment cycle.

Item Type:Articles
Additional Information:Financial support for this research was provided by a grant from Edinburgh and Lothians Health Foundation. P.A. Henriksen acknowledges the financial support of NHS Research Scotland, through NHS Lothian. P.A. Henriksen is chief investigator for the Cardiac CARE Study, which is funded by the Efficacy and Mechanism Evaluation Programme, an MRC and NIHR partnership and the British Heart Foundation. The EME Programme is funded by the MRC and NIHR, with contributions from the CSO in Scotland and NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. N.L. Mills is supported by the Butler Senior Clinical Research Fellowship (FS/16/14/32023) award from the British Heart Foundation. P.D. Adamson is supported by a National Heart Foundation of New Zealand Senior Fellowship (1844).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lang, Dr Ninian and Newby, Professor David and MacPherson, Dr Iain
Authors: Tzolos, E., Adamson, P.D., Hall, P.S., MacPherson, I.R., Oikonomidou, O., MacLean, M., Lewis, S.C., McVicars, H., Newby, D.E., Mills, N.L., Lang, N.N., and Henriksen, P.A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Clinical Oncology
Publisher:Elsevier
ISSN:0936-6555
ISSN (Online):1433-2981
Published Online:06 December 2019
Copyright Holders:Copyright © 2019 The Royal College of Radiologists
First Published:First published in Clinical Oncology 32(5): 292-297
Publisher Policy:Reproduced under a Creative Commons License

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