High-sensitive troponin T assay can predict anthracycline- and trastuzumab-induced cardiotoxicity in breast cancer patients
High-sensitive troponin T assay can predict anthracycline- and trastuzumab-induced cardiotoxicity in breast cancer patients
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DOI：
10.1007/s12282-017-0778-8
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发表时间：
2017-11-01
期刊：
影响因子：
4
通讯作者：
Tsuji, Yasushi
中科院分区：
文献类型：
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作者：
Kitayama, Hiromitsu;Kondo, Tomohiro;Tsuji, Yasushi
背景：在高达28%的患者中，服用蒽环类药物后曲妥珠单抗会引起心脏毒性。虽然一旦检测到心脏功能不全，心脏毒性往往是不可逆转的，但早期预测因素尚未建立。方法我们前瞻性地观察了在托南医院接受蒽环类药物或曲妥珠单抗治疗的乳腺癌患者。所有患者在化疗前和化疗期间每三个月进行一次超声心动图和采血。心脏毒性定义为左心室射血分数下降10%。结果40例患者中，34例(85%)接受了蒽环类药物(表阿霉素)治疗，18例(45%)接受曲妥珠单抗治疗，12例(30%)同时接受两种药物治疗。在4名患者(10%)中观察到心脏毒性，他们都接受了两种药物的治疗。4例心脏毒性患者高敏肌钙蛋白T(hs-TnT)绝对值均升高，且在检测心脏毒性前或检测时均达到最高点。有心脏毒性和无心脏毒性的患者hs-TnT最高水平无显著差异。心脏毒性患者的“hs-TnT从基线到最高值增加”和“hs-TnT积分值高于基线”显著增加(分别为0.039和0.007 ng/m L，P=0.046，0.113和0.022 ng月/m L，P=0.013)。Hs-TnT积分值具有100%的敏感性和特异度，以0.070 ng月/毫升为界值。结论hs-TnT测定可预测蒽环类药物和曲妥珠单抗对乳腺癌患者的心脏毒性，且hs-TnT增量或hs-TnT积分值高于绝对值时更可靠。
Background Trastuzumab following anthracycline causes cardiotoxicity in up to 28% of patients. Although the cardiotoxicity is often irreversible once cardiac dysfunction is detected, the early predictor has not been established yet.Methods We prospectively observed breast cancer patients treated with anthracycline or trastuzumab at Tonan Hospital. All patients underwent echocardiography and blood sampling at baseline, and every three months during chemotherapy. Cardiotoxicity was defined as a decline in left ventricular ejection fraction >10% points.Results Of 40 patients, 34 patients (85%) were treated with anthracycline (epirubicin), 18 (45%) with trastuzumab, and 12 (30%) with both agents. Cardiotoxicity was observed in four patients (10%), who were all treated with both agents. The absolute levels of high-sensitive troponin T (hs-TnT) were increased in all four patients with cardiotoxicity, and all the highest points were observed before or at the time of detection of cardiotoxicity. The highest level of hs-TnT was not significantly different in patients with and without cardiotoxicity. "Hs-TnT increment from baseline to the highest value" and "hs-TnT integration value above baseline" were significantly greater in patients with cardiotoxicity (0.039 vs. 0.007 ng/mL, P = 0.046, 0.113 vs. 0.022 ng months/mL, P = 0.013, respectively). The integration value had 100% sensitivity and specificity with a cutoff level at 0.070 ng months/mL.Conclusions Hs-TnT assay may be able to predict anthracycline-and trastuzumab-induced cardiotoxicity in breast cancer patients, and the hs-TnT increment or hs-TnT integration value above baseline was more reliable than the absolute value.