Asymptomatic Cardiotoxicity After High‐Dose Anthracycline Treatment in Sarcoma Patients Assessed by Biomarkers and Echocardiography

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.