Clinical Value of Cardiac Troponin I in Assessing Anthracycline-Induced Cardiotoxicity in Postoperative Breast Cancer Patients

Q: What are the key findings of this study?

Serum hs-cTnI >1358.5 pg/mL at cycle 3 independently predicted anthracycline-induced cardiotoxicity (aOR 15.42, 95% CI 6.78-35.08; AUC 0.957) in postoperative breast cancer patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Postoperative invasive breast cancer receiving adjuvant anthracycline-based chemotherapy (n=180). Intervention: Serum hs-cTnI >1358.5 pg/mL at the third chemotherapy cycle (T3) vs. Serum hs-cTnI =5% or asymptomatic decline >=10% to <55%) (OR 15.42, 95% CI 6.78-35.08, p=<0.001).

Q: What does this research mean for the field?

Serum high-sensitivity cardiac troponin I measured during mid-chemotherapy is a highly accurate predictive biomarker for anthracycline-induced cardiotoxicity in postoperative breast cancer patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hui Li; Xiaoxiong Li; Sijia Tang

doi:10.2147/bctt.s580515

January 1, 2026Breast Cancer Targets and TherapyOpen Access

Clinical Value of Cardiac Troponin I in Assessing Anthracycline-Induced Cardiotoxicity in Postoperative Breast Cancer Patients

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Key result

Cycle 3 hs-cTnI elevation linked to ~15.4-fold higher odds of anthracycline-induced cardiotoxicity.

OR 15.42
95% CI 6.78-35.08
P<0.001
n=180

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Why the study?

The study was conducted to investigate the clinical value of high-sensitivity cardiac troponin I in evaluating chemotherapy-related cardiac dysfunction induced by anthracyclines in postoperative breast cancer patients.

Does dynamic monitoring of serum high-sensitivity cardiac troponin I (hs-cTnI) accurately predict anthracycline-induced chemotherapy-related cardiac dysfunction (CTRCD) compared to NT-proBNP in postoperative breast cancer patients receiving CEF chemotherapy?

Study Design

Type

Cohort (n=180)

Blinding

Single-blind (cardiologist measuring LVEF blinded to biomarker results)

Multicenter

No

Structured PICO

Does dynamic monitoring of serum high-sensitivity cardiac troponin I (hs-cTnI) accurately predict anthracycline-induced chemotherapy-related cardiac dysfunction (CTRCD) compared to NT-proBNP in postoperative breast cancer patients receiving CEF chemotherapy?

P

Population

180 female postoperative breast cancer patients aged 20-60 years (mean age ~51.2 years) free of pre-existing cardiac disease, monitored across 6 cycles (18 weeks) of adjuvant CEF chemotherapy.

E

Exposure

Dynamic monitoring of serum high-sensitivity cardiac troponin I (hs-cTnI) before chemotherapy (T0) and after each of six cycles of cyclophosphamide-epirubicin-fluorouracil (CEF) chemotherapy (T1-T6).

C

Comparator

Dynamic monitoring of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) by echocardiography across the same chemotherapy cycles (T0 to T6); comparison between cardiotoxicity (n=50) and non-cardiotoxicity (n=130) groups.

O

Outcome

Predictive value for anthracycline-induced chemotherapy-related cardiac dysfunction (CTRCD) defined by Chinese Society of Clinical Oncology (CSCO) guideline criteria across six cycles of chemotherapy.surrogate

Main Result

Odds Ratio: 15.42 (95% CI 6.78–35.08)

p-value: p=<0.001

Serum hs-cTnI measured at the third cycle of anthracycline chemotherapy provides superior predictive accuracy (AUC 0.957) over NT-proBNP for identifying breast cancer patients who will develop chemotherapy-related cardiac dysfunction.

Limitations

Single-center, retrospective design may introduce selection bias and limits generalizability.
All patients received a standardized CEF regimen with epirubicin (cumulative dose 600 mg/m2), requiring validation in cohorts treated with other anthracyclines or combination regimens.
Advanced echocardiographic parameters such as global longitudinal strain (GLS) were not routinely acquired during the study period and were unavailable for analysis.
Incomplete documentation of baseline cardiovascular comorbidities and medications limited adjustment for potential confounding effects.
Absence of long-term follow-up precludes assessment of late-onset heart failure or mortality.

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Answers are grounded in this paper and cite their sources.

Implication

hs-cTnI at cycle 3 may aid risk stratification; leaves open prospective validation before changing practice in anthracycline-treated breast cancer.

Abstract

Objective To investigate the clinical value of high-sensitivity cardiac troponin I (hs-cTnI) in evaluating chemotherapy-related cardiac dysfunction (CTRCD) induced by anthracyclines in postoperative breast cancer patients. Methods A retrospective study was conducted including 180 postoperative breast cancer patients treated at our hospital from August 2021 to August 2024. All patients completed six cycles of the cyclophosphamide–epirubicin–fluorouracil (CEF) regimen. According to the Chinese Society of Clinical Oncology (CSCO) guideline criteria, patients were divided into a cardiotoxicity group (n = 50) and a non-cardiotoxicity group (n = 130). Serum hs-cTnI and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, as well as left ventricular ejection fraction (LVEF) measured by echocardiography, were dynamically monitored before chemotherapy (T0) and after each chemotherapy cycle (T1–T6). The predictive value of each marker for CTRCD was evaluated using receiver operating characteristic (ROC) curves. Results Compared with the non-cardiotoxicity group, the cardiotoxicity group showed significantly higher serum hs-cTnI and NT-proBNP levels from T1 onward, with progressive increases over chemotherapy cycles (P < 0.01), while LVEF progressively decreased (P < 0.01). ROC analysis indicated that serum hs-cTnI at the third chemotherapy cycle (T3) had an area under the curve (AUC) of 0.957 (95% CI: 0.905–0.988) for predicting CTRCD, with an optimal cutoff value of >1358.5 pg/mL, yielding a sensitivity of 92.00% and specificity of 91.54%. Its predictive performance was significantly superior to that of NT-proBNP at the same time point [AUC = 0.684 (95% CI: 0.590–0.763)]. Conclusion Serum hs-cTnI is a highly sensitive and specific biomarker for the early and dynamic monitoring of anthracycline-induced cardiotoxicity. The hs-cTnI level at mid-chemotherapy (third cycle) has excellent predictive value for CTRCD, facilitating early identification of high-risk patients and timely clinical intervention.

Discussion

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Cite This Study

Li et al. (2026) conducted a cohort in Postoperative invasive breast cancer receiving adjuvant anthracycline-based chemotherapy (n=180). Serum hs-cTnI >1358.5 pg/mL at the third chemotherapy cycle (T3) vs. Serum hs-cTnI <=1358.5 pg/mL at the third chemotherapy cycle (T3) was evaluated on Anthracycline-induced cardiotoxicity (chemotherapy-related cardiac dysfunction, defined as symptomatic LVEF decline >=5% or asymptomatic decline >=10% to <55%) (OR 15.42, 95% CI 6.78-35.08, p=<0.001). Serum hs-cTnI >1358.5 pg/mL at cycle 3 independently predicted anthracycline-induced cardiotoxicity (aOR 15.42, 95% CI 6.78-35.08; AUC 0.957) in postoperative breast cancer patients.

synapsesocial.com/papers/6a7025a4c1a24a6142db7306 https://doi.org/10.2147/bctt.s580515

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Clinical Value of Cardiac Troponin I in Assessing Anthracycline-Induced Cardiotoxicity in Postoperative Breast Cancer Patients

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical Value of Cardiac Troponin I in Assessing Anthracycline-Induced Cardiotoxicity in Postoperative Breast Cancer Patients

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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