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The Utility of Cardiac Biomarkers During Anthracycline Chemotherapy for the Detection of
Cardiac Events: Comparison Left Ventricular Ejection Fraction
Stevens, Patrick L, MD, Lenihan, Daniel J, MD
Background: An effective strategy for monitoring cardiac safety during anthracycline chemotherapy is not
established. Serial left ventricular ejection fraction (LVEF) utilizing imaging is the current standard of
care; however biomarkers may allow for earlier identification and treatment.
Methods: A prospective, single-center study in which 51 cancer patients undergoing anthracycline
chemotherapy were monitored with cardiac biomarkers, B-type natriuretic peptide (BNP) and highsensitivity Troponin I (hs-cTnI), prior to each cycle of anthracycline chemotherapy and every 6 months
echocardiogram (Echo) over 1 year. A cardiac event was defined as: symptomatic heart failure (CHF),
acute coronary syndrome, symptomatic arrhythmia, and asymptomatic drop in LVEF (Asym EF). At
baseline, 18 out of 51 patients were on cardioprotective medications. Statistical analysis was performed
using Wilcoxon test.
Results: Cardiac events were observed in 7 out of 51 patients, including 4 with CHF, 2 with Asym EF,
and 1 with symptomatic arrhythmia. There was no significant reduction in LVEF from baseline to 6
months or 1 year for the whole group and in those with cardiac events, only 3 out of 7 met LVEF criteria
for toxicity. Of these BNP was elevated to >100 pg/ml in 7/7 patients. There was a significant change in
magnitude of BNP and hs-cTnI values from baseline for patients who reported symptoms of edema
(p=0.019, p=0.004) and fatigue (p=0.01, p=0.05), as well as for dyspnea at rest for BNP alone (p=0.013).
An absolute change of hs-cTnI >11pg/ml was associated with a 7% absolute reduction of LVEF. Of
patients not experiencing a cardiac event, BNP was elevated to >100 pg/ml in 9 patients, 5 of these were
on cardioprotective medications. There was a strong correlation between a significant rise in hs-cTnI and
BNP from baseline for patients who had a cardiac event (R=0.7, p<0.01).
Conclusions: The combination of hs-cTnI to BNP may add to the sensitivity and specificity for detection
of future cardiac events.