Early Diagnostic Value of High-Sensitivity Cardiac Troponin T for Cancer Treatment-Related Cardiac Dysfunction: A Meta-Analysis

Figures

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  Figure 1. Flowchart of study selection. From the four databases, 3578 studies were initially retrieved, 960 were duplicate studies, 1321 studies did not fit the topic, and 1257 reviews, conference abstracts, meta‐analyses, reviews, letters, case reports, and animal studies were removed. The full text of the remaining 40 studies was read, 31 studies that did not meet the inclusion criteria were excluded, and one of the remaining nine studies was excluded because data could not be extracted, resulting in the inclusion of eight studies.

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  Figure 2. Risk of bias assessment. The risk of bias was assessed for the included studies using the Quality Assessment of Studies in Diagnostic Accuracy (QUADAS‐2) tool on ReviewManager 5.2 software. In the Patient Selection domain, two studies had an unclear risk of bias. In the Index Test domain, seven studies had a high risk of bias and one study had an unclear risk of bias. Five studies in the Reference Standard domain had an unclear risk of bias. In the Flow and Timing domain, four studies were at a high risk of bias; one study was at a high risk of bias in terms of clinical applicability.

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  Figure 3. Sensitivity and specificity forest plot. Sensitivity and specificity analyses were performed using STATA 16.0 software with a random‐effects model. The results showed a combined sensitivity of 0.78 [95% confidence interval (CI): 0.64–0.88] and a specificity of 0.75 (95% CI: 0.59–0.86).

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  Figure 4. Summary receiver operating characteristic (SROC) curve of diagnostic performance of high‐sensitivity cardiac troponin T in detecting cancer treatment‐related cardiac dysfunction. The SROC curve was constructed using STATA 16.0 software, and the area under the curve (AUC) was 0.83 (95% confidence interval: 0.80–0.86).

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  Figure 5. Publication bias. The Deeks' funnel plot was largely symmetrical (P = 0.74); hence, publication bias was not observed. ESS, effective sample size.

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  Figure 6. Fagan plot of pre‐test and post‐test probabilities of high‐sensitivity cardiac troponin T (hs‐cTnT). The positive likelihood ratio of hs‐cTnT for cancer treatment‐related cardiac dysfunction diagnosis was 3.1 [95% confidence interval (CI): 1.8–5.4], negative likelihood ratio was 0.29 (95% CI: 0.17–0.50), and pre‐test probability was set at 25% (the median of the included studies) to draw the Fagan nomogram. The pre‐test and post‐test probabilities were 51% and 9%, respectively, indicating that the possibility of cardiotoxicity increased from 25% to 51% after hs‐cTnT diagnosis and that the possibility of no cardiotoxicity decreased from 25% to 9%. LR_Negative, negative likelihood ratio; LR_Positive, positive likelihood ratio.