A prospective study of cardiac biomarkers in monitoring cardiac arrhythmia in Non-Hodgkin's lymphoma chemotherapy

Q: What are the key findings of this study?

Interval increases in hs-TnT (adjusted OR 1.29, P=0.04) and sST2 (adjusted OR 1.26, P=0.038) by cycle 2 predicted cardiac arrhythmia during CHOP chemotherapy in non-Hodgkin's lymphoma (AUC 0.866).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Non-Hodgkin's lymphoma undergoing CHOP chemotherapy (n=45). Intervention: Interval increase in hs-TnT and sST2 from baseline to cycle 2 during CHOP chemotherapy vs. Normal electrocardiogram group (no arrhythmia). Primary outcome: Cancer therapy-related cardiac arrhythmia (per unit increase in Δhs-TnT from baseline to cycle 2 in multivariate logistic regression) (OR 1.29, 95% CI 1.00-1.67, p=0.04).

Q: What does this research mean for the field?

Early interval increases in serum hs-TnT and sST2 independently predict cardiac arrhythmia during CHOP chemotherapy in patients with non-Hodgkin's lymphoma. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Cuncun Chen; Lishan Sun; Lin Guo; Renquan Lu

doi:10.21203/rs.3.rs-10672012/v1

October 20, 2026Open Access

A prospective study of cardiac biomarkers in monitoring cardiac arrhythmia in Non-Hodgkin's lymphoma chemotherapy

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Key result

Rising hs-TnT by cycle 2 is linked to ~29% higher arrhythmia odds per unit during CHOP chemotherapy.

OR 1.29
95% CI 1.00-1.67
P=0.04
n=45

Why the study?

The utility of serum cardiac biomarkers for monitoring and predicting cardiac arrhythmia in non-Hodgkin's lymphoma patients undergoing the CHOP chemotherapy regimen required evaluation.

Does early monitoring of serum cardiac biomarkers (hs-TnT, NT-proBNP, sST2, and H-FABP) predict chemotherapy-induced cardiac arrhythmia and LVEF decline in patients with non-Hodgkin's lymphoma undergoing CHOP chemotherapy?

Key Points

To evaluate dynamic changes in serum biomarkers and echocardiographic parameters for predicting cardiac arrhythmia in non-Hodgkin lymphoma patients undergoing CHOP chemotherapy.
A prospective study enrolled 45 non-Hodgkin lymphoma patients receiving CHOP chemotherapy between January 2022 and December 2023.
Patients were divided based on electrocardiograms into an arrhythmia group (n=24) and a normal group (n=21).
Serum hs-TNT, sST2, NT-proBNP, and H-FABP alongside echocardiographic LVEF were measured at baseline and before chemotherapy cycles C1 through C4.
Univariate logistic regression demonstrated that interval increases from baseline to cycle C2 in hs-TNT (OR 1.19, 95% CI 1.02–1.37, P=0.024) and sST2 (OR 1.17, 95% CI 1.01–1.36, P=0.042), alongside decline in LVEF (OR 0.66, 95% CI 0.462–0.943, P<0.05), predicted arrhythmia.
Multivariate analysis adjusting for age, BMI, and diabetes confirmed significant associations for △hs-TNT (OR 1.29, 95% CI 1.00–1.67, P=0.04), △sST2 (OR 1.26, 95% CI 1.01–1.58, P=0.038), and declining △LVEF (OR 0.57, 95% CI 0.35–0.92, P=0.023).
ROC curve analysis yielded AUC values of 0.795 for △hs-TNT, 0.683 for △sST2, and 0.866 for the combined △(sST2 + hs-TNT) model (P<0.05), which achieved 75% sensitivity and 94.74% specificity.

Study Design

Type

Cohort (n=45)

Multicenter

No

Structured PICO

Does early monitoring of serum cardiac biomarkers (hs-TnT, NT-proBNP, sST2, and H-FABP) predict chemotherapy-induced cardiac arrhythmia and LVEF decline in patients with non-Hodgkin's lymphoma undergoing CHOP chemotherapy?

P

Population

45 newly diagnosed adult non-Hodgkin's lymphoma patients (median age 53.22 years), free of recent cardiac or vascular disease, treated with 4 to 6 cycles of CHOP-related chemotherapy.

E

Exposure

Serial monitoring of serum cardiac biomarkers—high-sensitivity troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble growth-stimulated expressed gene 2 (sST2), and heart fatty acid-binding protein (H-FABP)—along with echocardiography and ECG at baseline and prior to each cycle of CHOP-related chemotherapy (cyclophosphamide, doxorubicin/hydroxydaunorubicin, vincristine, and prednisone) over 4 to 6 cycles.

C

Comparator

Patients who maintained a normal electrocardiogram (normal group, n=21) vs. patients who developed cardiac arrhythmia (arrhythmia group, n=24) during CHOP chemotherapy.

O

Outcome

Cancer therapy-related cardiac arrhythmia (categorized into bradycardia or tachycardia, including atrial fibrillation) detected by electrocardiogram during chemotherapy cycles C1 to C4.safety

Main Result

Odds Ratio: 1.29 (95% CI 1–1.67)

p-value: p=0.04

Early elevations in serum hs-TnT and sST2 by the second cycle of CHOP chemotherapy independently predict the development of cardiac arrhythmias prior to subsequent declines in LVEF in patients with non-Hodgkin's lymphoma.

Limitations

Modest sample size (n=45) restricting statistical power and generalizability
Data collection confined to baseline and active treatment phase without longitudinal post-treatment follow-up
Lack of internal validation strategies (such as training/test split) or external validation in independent cohorts
Relatively modest sample size (n=45) restricting statistical power and generalizability
Data collection was confined to baseline and the active treatment phase, lacking longitudinal post-treatment follow-up data
Limited sample size precluded robust internal validation strategies such as splitting the cohort into training and test sets

Implication

May support early arrhythmia risk stratification during CHOP; hypothesis-generating and requires prospective validation before practice change.

Abstract

Background This study aims to evaluate serum biomarkers of cardiac arrhythmia in non-Hodgkin’s lymphoma (NHL) patients undergoing Cyclophosphamide, Hydrocydaunoruicin, Oncovin and Prednisone (CHOP) chemotherapy regimen. Methods A prospective study was conducted involving 45 NHL patients from January 2022 to December 2023. Based on electrocardiogram, patients were categorized into arrhythmia group (24 cases) and normal group (21 cases). Serum levels of high-sensitivity troponin T (hs-TNT), N-terminal brain natriuretic peptide (NT-proBNP), soluble growth-stimulated expressed gene 2 (sST2), and myocardial-type fatty acid-binding protein (H-FABP) at baseline and before each chemotherapy cycle were analyzed. Logistic regression analyses and receiver operating characteristic (ROC) curves were employed to assess associations between biomarkers and cardiac arrhythmia. Results Hs-TNT levels exhibited significant increase from baseline to cycles C1-C4 (P < 0.01). sST2 levels showed a notable rise during cycle C2 compared to baseline (P < 0.01). Univariate logistic regression analysis indicated that interval changes in hs-TNT presented a greater risk for arrhythmia (with an odds ratio of OR:1.19; 95% CI: 1.02–1.37; P = 0.024), sST2 (OR:1.17; 95% CI: 1.01–1.36; P = 0.042), as well as in LVEF OR = 0.66 (0.462–0.943, P < 0.05). Consulting confounding factors, multivariate analysis revealed that △hs-TNT, △sST2 and △LVEF also predicted significant associations with arrhythmia. The ROC curve analysis demonstrated that △hs-TNT, △sST2, and △(sST2 + hs-TNT) provided good predictive values for arrhythmia, with areas under the curves measuring at 0.795, 0.683, and 0.866 respectively (P < 0.05). Conclusions Early detection of alterations in hs-TnT and sST2 may partially predict cardiac arrhythmia and changes of LVEF intensively associated with arrhythmia due to chemotherapy in NHL patients.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cohort in Non-Hodgkin's lymphoma undergoing CHOP chemotherapy (n=45). Interval increase in hs-TnT and sST2 from baseline to cycle 2 during CHOP chemotherapy vs. Normal electrocardiogram group (no arrhythmia) was evaluated on Cancer therapy-related cardiac arrhythmia (per unit increase in Δhs-TnT from baseline to cycle 2 in multivariate logistic regression) (OR 1.29, 95% CI 1.00-1.67, p=0.04). Interval increases in hs-TnT (adjusted OR 1.29, P=0.04) and sST2 (adjusted OR 1.26, P=0.038) by cycle 2 predicted cardiac arrhythmia during CHOP chemotherapy in non-Hodgkin's lymphoma (AUC 0.866).

synapsesocial.com/papers/6ae28f3bcbadf70daf6c443f https://doi.org/10.21203/rs.3.rs-10672012/v1

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A prospective study of cardiac biomarkers in monitoring cardiac arrhythmia in Non-Hodgkin's lymphoma chemotherapy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

A prospective study of cardiac biomarkers in monitoring cardiac arrhythmia in Non-Hodgkin's lymphoma chemotherapy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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