4761 - High-sensitivity troponin as a cardiotoxicity biomarker in breast cancer treatment

Background

Cardiotoxicity is one of the effects described with anthracyclines (AC) or antiHER2 therapies. Monitoring is usually performed with an echocardiogram and the main effect is the left ventricular ejection fraction reduction. On the other hand, cardiotoxicity biomarkers, such as high-sensitivity troponin (TropHS), can be evaluated at shorter intervals and have been described as an early diagnosis indicator of myocardial injury.

Methods

Retrospective analysis of 83 breast cancer patients undergoing neoadjuvant or adjuvant chemotherapy with AC, with or without antiHER2 therapy, from January 2017 to July 2018. All patients were evaluated with cardiotoxicity biomarkers, electrocardiogram and transthoracic echocardiogram prior to treatment, and 3, 6, 9 and 12 months thereafter. After assessment of the cardiovascular risk, cardioprotective therapy has been initiated in patients with TropHS elevation. Cardiotoxicity was defined by a decline in LVEF> 10% of baseline or LVEF <50%.

Results

The median age was 49 years (26-76) and 14.5% of the patients had history of cardiovascular disease (namely arterial hypertension). Almost 29% (n = 24) were treated with association of antiHER2 therapy and the median chemotherapy treatment time was 3.8 months (1-6). About 84% (n = 70) were submitted to adjuvant radiotherapy. Eight percent had a very high (7) Cardiotoxicity Risk Score, being most of them of the group with TropHS elevation. Almost 57% (n = 47) of the patients presented TropHS elevation and we observed a major elevation at 3 months treatment, with a median of 21.25 (1.90-209.0). Approximately 5% (n = 4) of the patients had cardiotoxicity, all of them treated with combination of antiHER2 therapy, and this was more frequent in patients with TropHS elevation (p = 0.215). Among 15 patients who presented TropHs elevation and started cardioprotective therapy, only three developed cardiotoxicity. The median follow-up was 12 months (3-23).

Conclusions

Recently, the role of TropHS, as a biomarker in the early identification of cardiotoxicity, has been affirmed. The consequent use of cardioprotective agents has emerged as an effective approach in the prevention of cardiac dysfunction. For the moment, more studies are needed to validate this biomarker in clinical practice.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.