High-sensitivity cardiac troponin T determines all-cause mortality in cancer patients: a single-centre cohort study

  • Aims: Cardio-oncology is a growing interdisciplinary field which aims to improve cardiological care for cancer patients in order to reduce morbidity and mortality. The impact of cardiac biomarkers, echocardiographic parameters, and cardiological assessment regarding risk stratification is still unclear. We aimed to identify potential parameters that allow an early risk stratification of cancer patients. Methods and results: In this cohort study, we evaluated 930 patients that were admitted to the cardio-oncology outpatient clinic of the University Hospital Heidelberg from January 2016 to January 2019. We performed echocardiography, including Global Longitudinal Strain (GLS) analysis and measured cardiac biomarkers including N-terminal pro brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T levels (hs-cTnT). Most patients were suffering from breast cancer (n = 450, 48.4%), upper gastrointestinal carcinoma (n = 99, 10.6%) or multiple myeloma (n = 51, 5.5%). At the initial visit, we observed 86.7% of patients having a preserved left ventricular ejection fraction (LVEF >50%). At the second follow up, still 78.9% of patients showed a preserved LVEF. Echocardiographic parameters or elevation of NT-proBNP did not significantly correlate with all-cause mortality (ACM) (logistic regression LVEF <50%: P = 0.46, NT-proBNP: P = 0.16) and failed to identify high-risk patients. In contrast, hs-cTnT above the median (≥7 ng/L) was an independent marker to determine ACM (multivariant logistic regression, OR: 2.21, P = 0.0038) among all included patients. In particular, hs-cTnT levels before start of a chemotherapy were predictive for ACM. Conclusions: Based on our non-selected cohort of cardio-oncological patients, hs-cTnT was able to identify patients with high mortality by using a low cutoff of 7 ng/L. We conclude that measurement of hs-cTnT is an important tool to stratify the risk for mortality of cancer patients before starting chemotherapy.
Author:Daniel Finke, Sebastian W. Romann, Markus B. Heckmann, Hauke Hund, Nina Bougatf, Ajith Kantharajah, Hugo Katus, Oliver J. Müller, Norbert Frey, Evangelos Giannitsis, Lorenz Lehmann
Parent Title (English):ESC heart failure
Place of publication:Chichester
Document Type:Article
Date of Publication (online):2021/08/15
Date of first Publication:2021/08/15
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/03/10
Tag:Risk stratification
Cancer survivors; Cardiac biomarkers; Cardio-oncology; Cardiotoxicity; Heart failure
Page Number:11
First Page:3709
Last Page:3719
M.H. is recipient of the rotation grant of the German Centre for Cardiovascular Research (DZHK). L.H.L. is supported by the Deutsche Forschungsgemeinschaft (DFG; LE 3570/2-1; 3570/3-1) and the Bundesministerium für Forschung (BMBF; 01KC2006B).
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0