Assessment of predictors of anthracycline-induced heart failure

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objectives Chemotherapy-induced cardiotoxicity is a growing clinical problem, which is increasing and has acquire more importance in recent years. The objective of this study was to determine the incidence of anthracycline-induce cardiomyotoxicity in patients with Non-Hodkin´s Lymphoma (NHL), quantified by serial measurements of biomarkers (highly sensitive troponin I and Nt-proBNP) and echocardiophic imaging: 2D left ventricle ejection fraction (LVEF) and myocardial deformation, assessed by global longitudinal strain (GLS). Material and methods Observational, prospective study. We included 50 patients diagnosed with NHL between January 2018-January 2020, with a mean follow-up of 30.2 months. Patients were treated with liposomal doxorubicin and had no history of previous known heart disease. Statistical analysis was performed to evaluate the association between biomarkers, imaging parameters and time to development of cardiomyotoxicity. Results The cumulative incidence of cardiomyotoxicity was 6.3% at 6 months, 10.8% at 1 year, and 16% at 2 years. The median time to development of cardiomyotoxicity was 7.1 months. Both troponin, Nt-proBNP and GLS levels were independently associated with increased risk of cardiomyotoxicity (p < 0.05). Regarding troponin levels, they were found to be elevated in 23.2% of the patients. Elevation in troponin analysis was associated with an increased risk of left ventricular dysfunction (odds ratio OR 10.2). Patients with Nt-proBNP > 680 pg/ml had a 4.1-fold increased risk of presenting cardiomyotoxicity. GLS with a value of -16.1% showed 80% sensitivity and 98.2% specificity for the diagnosis of cardiomyotoxicity. Conclusions Chemotherapy with Doxorubicin is associated with an increased risk of cardiomyotoxicity. IN our study, significant variations in baseline troponin levels, NT-proBNP, and GLS were powerful predictors of its development. These parameters could identify groups of patients with different risk of cardiotoxicity, in whom cardiological evaluation and personalized follow-up should be offered.