Key result
A rise in high-sensitive troponin T within the normal range during breast cancer treatment predicted a ≥10% drop in left ventricular ejection fraction (predictive value 0.78; 95% CI 0.67-0.90; p=0.05).
Why the study?
The increase in high-sensitive cardiac troponin T below the upper limit of normal in response to chemotherapy had not previously been studied.
Does a rise in high-sensitive troponin T within the normal range predict left ventricular dysfunction in breast cancer patients undergoing systemic cancer treatment?
Observational (n=60)
Open-label
Does a rise in high-sensitive troponin T within the normal range predict left ventricular dysfunction in breast cancer patients undergoing systemic cancer treatment?
Effect estimate: 0.78 (95% CI 0.67-0.90)
p-value: p=0.05
A relative increase in high-sensitive troponin T of >81% within the normal reference range (<14 ng/L) during systemic breast cancer treatment is a valuable predictor of early left ventricular dysfunction at 6 months.
May support hsTnT monitoring for early LV dysfunction risk in breast cancer therapy; hypothesis-generating pending prospective validation.
Background: We investigated the role of a high-sensitive cardiac troponin T (hsTnT) increase below the upper limit of normal (ULN) in patients with breast cancer (BC). hsTnT assays accurately quantify very low plasma troponin concentrations and enable the early detection of cardiomyocyte injury before a drop in the left ventricular ejection fraction (LVEF). The increase in hsTnT below the ULN in response to chemotherapy has not previously been studied. Method: This was an open-label pilot study. Female patients with newly diagnosed BC scheduled to receive systemic cancer treatment were recruited. Blood sampling and echocardiography were performed at baseline, at 3 and 6 months of cancer treatment. hsTnT concentrations were measured using the Elecsys TnT hs assay (Roche Diagnostics). The limit of blank and 99th percentile cutoff values for the hsTnT assay were 3 and 14 ng/L. We calculated the rise in hsTnT (ΔhsTnT) by the difference (%) between its baseline level and during follow-up (FU) in each patient. Results: Among eligible subjects, we excluded 4 patients before the start of treatment and 17 patients during the follow-up with values for the hsTnT >14 ng/L. Finally, 60 women with a median age of 48.6 ± 1.3 years were included in the study. The median baseline hsTnT concentration was 5.5 ± 1.4 ng/L. During 6 months of cancer treatment, hsTnT increased in all patients by up to 10–305% from baseline, with an average of 94.2%. LV EF was normal at baseline and decreased significantly compared to the value before cancer treatment (61.9 ± 3.3% vs. 56.3 ± 7.0%; p < 0.045). We correlated the hsTnT rise with a drop in LV EF ≥ 10% from its baseline level. Logistic regression analysis showed that Δ hsTnT has a good predictive value for LV dysfunction, 0.78 (p = 0.05), 95% CI (0.67–0.90). The increase in hsTnT > 81% was determined as the optimal threshold value for detecting early biochemical cardiotoxicity. Conclusion: It was investigated that hsTnT rise within the cutoff < 14 ng/L can be used as a marker of early biochemical cardiotoxicity and is valuable for predicting LV drop in 6 months of FU. We conclude that BC patients with increased hsTnT plasma concentration > 81% from the baseline value should be considered as high-risk patients for cardiotoxicity and need more precise cardiac monitoring and early preventive medical intervention strategies.
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Kozhukhov et al. (2025) conducted an observational in Breast cancer (n=60). Rise in high-sensitive cardiac troponin T (ΔhsTnT) within the upper reference limit was evaluated on Drop in left ventricular ejection fraction ≥ 10% from baseline (0.78, 95% CI 0.67-0.90, p=0.05). A rise in high-sensitive troponin T within the normal range during breast cancer treatment predicted a ≥10% drop in left ventricular ejection fraction (predictive value 0.78; 95% CI 0.67-0.90; p=0.05).
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