Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy.

Abstract

BACKGROUND:

In patients with aggressive malignancies who are undergoing high-dose chemotherapy, even minimal elevation of troponin I (TnI) is associated with late left ventricular dysfunction. The time course of the subclinical myocardial damage and its impact on the clinical outcome have never been investigated previously.

METHODS AND RESULTS:

In 703 cancer patients, we measured TnI soon after chemotherapy (early TnI) and 1 month later (late TnI). Troponin was considered positive for values > or =0.08 ng/mL. Clinical and left ventricular ejection fraction evaluation (echocardiography) were performed before chemotherapy, 1, 3, 6, and 12 months after the end of the treatment, and again every 6 months afterward. Three different TnI patterns were identified, and patients were grouped accordingly. In 495 patients, both early and late TnI values were <0.08 ng/mL (TnI-/- group); in 145, there was only an early increase (TnI+/- group); and in 63 patients, both values increased (TnI+/+ group). In the TnI-/- group, no significant reduction in ejection fraction was observed during the follow-up, and there was a very low incidence of cardiac events (1%). In contrast, a greater incidence of cardiac events occurred in TnI-positive patients, particularly in the TnI(+/+) group (84% versus 37% in the TnI+/- group; P<0.001).

CONCLUSIONS:

TnI release pattern after high-dose chemotherapy identifies patients at different risks of cardiac events in the 3 years thereafter. This stratification allows us to differentiate the monitoring program and to plan, in selected patients, preventive strategies aimed at improving clinical outcome.

• Authors: Daniela Cardinale, Maria T Sandri, Alessandro Colombo, Nicola Colombo, Marina Boeri, Giuseppina Lamantia, Maurizio Civelli, Fedro Peccatori, Giovanni Martinelli, Cesare Fiorentini, Carlo M Cipolla
• Journal: Circulation (Circulation) Vol. 109 Issue 22 Pg. 2749-54 (Jun 08 2004) ISSN: 1524-4539 [Electronic] United States
• PMID: 15148277 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Biomarkers
• Troponin I

Topics

• Adult
• Antineoplastic Agents (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Biomarkers (blood)
• Female
• Follow-Up Studies
• Heart Diseases (blood, chemically induced, epidemiology)
• Humans
• Male
• Middle Aged
• Neoplasms (blood, drug therapy)
• Predictive Value of Tests
• Prospective Studies
• Risk
• Time Factors
• Troponin I (blood)