October 14, 2008Open Access
View Full PaperBiochemical Markers for Prediction of Chemotherapy-Induced Cardiotoxicity
Key Result
Cardiac troponins show high diagnostic efficacy as early as 3 months before the clinical onset of chemotherapy-induced cardiomyopathy, with a negative predictive value of 99%.
Structured PICO
Do biochemical markers (cardiac troponins and natriuretic peptides) improve the early prediction of chemotherapy-induced cardiotoxicity compared to echocardiography in patients undergoing chemotherapy?
P
Population
Patients undergoing chemotherapy at risk for cardiotoxicity
E
Exposure
Biochemical markers (cardiac troponins and natriuretic peptides)
C
Comparator
Echocardiography (estimation of left ventricular ejection fraction)
O
Outcome
Prediction of chemotherapy-induced cardiomyopathy/cardiotoxicitysurrogate
Cardiac troponins are highly effective for the early prediction of chemotherapy-induced cardiomyopathy, whereas the role of natriuretic peptides remains unclear.
Limitations
- Definitive evidence in regard to a diagnostic or prognostic role of cardiac natriuretic peptides in predicting chemotherapy-induced cardiomyopathy is still lacking.
Abstract
Chemotherapy is a well-established therapeutic approach for several malignancies, but its clinical efficacy is often limited by its related cardiotoxicity, which leads to cardiomyopathy, possibly evolving into heart failure. To detect cardiac damage, the adopted diagnostic approach is the estimation of left ventricular ejection fraction by echocardiography. This approach shows low sensitivity toward early prediction of cardiomyopathy, when the possibilities of appropriate treatments could still improve the patient's outcome. Cardiac troponins, however, show high diagnostic efficacy as early as 3 months before the clinical onset of cardiomyopathy. The increase in their concentrations is correlated with disease severity and may predict the new onset of major cardiac events during follow-up. Negative troponin concentrations may identify patients with a very low risk of cardiomyopathy (negative predictive value, 99%). Concerning cardiac natriuretic peptides, definitive evidence in regard to a diagnostic or prognostic role in predicting chemotherapy-induced cardiomyopathy is still lacking.