Cardiovascular Biomarkers in Cardio-Oncology: Antineoplastic Drug Cardiotoxicity and Beyond

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  Figure 1. Beyond cancer therapy-related cardiac dysfunction (CTRCD): bidirectional relationship between cancer and heart disease. (a) Increased levels of natriuretic peptides and troponins have been found in cancer patients, even before the introduction of anticancer therapy, without evidence of abnormal cardiac function. Malignant cells are capable of producing vasoactive peptides, such as vasopressin or endothelin-1, as well as cardiac neurohormones, such as NPs. (b) Cancer and cardiovascular disease share many risk factors, as well as a common underlying inflammatory condition. Some serum inflammatory markers such as C-reactive protein (CRP) and proinflammatory cytokines like interleukin 6 (IL-6) are expressed in both cancer and heart failure. (c) Patients affected by HF present with high serum levels in several biomarkers presumed to be tumor-related, such as CA19-9, CA125 and human epididymis protein 4 (HE4). In particular, CA125 has shown prognostic value in different cardiac settings and HE4 is demonstrated to be strongly associated with HF. (d) Metabolomics could represent a sensitive and promising tool in cardio-oncology research, including more efficient follow-up in all patients…