Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Coronary artery disease wikipedia , lookup
Remote ischemic conditioning wikipedia , lookup
Cardiac surgery wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
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.