Abstract
Simple SummaryCardiac biomarkers have proved increasingly useful in the various branches of cardiology, not sparing the field of cardio-oncology. With specific reference to the latter subject, they have been investigated as predictors and/or diagnostic and monitoring tools, as well as prognostic factors, with the purpose of allowing the early prevention of many cardiovascular complications related to the direct action of some cancer types or related to the toxicity of its treatments. However, despite this great potential and excellent cost-effectiveness, their usefulness in some areas still seems to be limited due to lack of sufficient specificity or sensitivity. In fact, in clinical practice, while their use is nowadays standard in some circumstances, evidence does not yet support their routine use in other cases.In patients with cancer—and especially some specific subtypes—the heart can be pathologically affected due to the direct action of the tumor or its secretion products or due to the toxicity of some oncological treatments. Cardiac biomarkers have been investigated as inexpensive and easily accessible tools for prediction, early diagnosis, monitoring, or prognosis of various forms of cancer-related cardiac diseases. However, their clinical usefulness was not always clearly demonstrated in every area of cardioncology. For the identification of anthracycline related cardiotoxicity in the very early stages troponins proved to be more efficient detectors than imaging methods. Nevertheless, the lack of a standardized dosage methodology and of cardiotoxicity specific thresholds, do not yet allow to outline the precise way to employ them in clinical routine and to incorporate them into appropriate diagnostic or managing algorithms. Cardiac biomarkers proved also effective in patients with primary cardiac amyloidosis, in which both troponins and natriuretic peptides were able to predict adverse outcome, and carcinoid heart disease, where a precise diagnostic cut-off for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was identified to screen patients with valvular involvement. Likewise, NT-proBNP proved to be an excellent predictor of postoperative atrial fibrillation (POAF). On the contrary, evidence is still not sufficient to promote the routine use of cardiac biomarkers to early diagnose myocarditis due to immune check points inhibitors (ICIs), radiotherapy induced cardiotoxicity and cardiac complications related to androgenetic deprivation. In this review we present all the evidence gathered so far regarding the usefulness and limitations of these relatively inexpensive diagnostic tools in the field of cardio-oncology.
Highlights
Heart disease secondary to cancer can be divided in two main strands on the basis of the causative mechanism: iatrogenic cardiac damage due to cancer treatments toxicity and direct cardiac damage caused by the tumor itself
The prediction of left ventricular dysfunction (LVD) caused by chemotherapy with high anthracycline doses and the diagnosis of cardiotoxicity in an early subclinical stage, i.e., when it is still undetectable with standard cardiovascular imaging methods, are i.e., when it isthe still undetectable with cardiovascular methods, are un-has undoubtedly clinical purposes forstandard which the employmentimaging of cardiac biomarkers doubtedly the clinical purposes for which the employment of cardiac biomarkers has been been most analysed in cardioncology to date
In 2010 Cardinale et al carried out a study including 251 women with breast cancer that investigated troponin as a predictor of future LVD related to trastuzumab treatment
Summary
Heart disease secondary to cancer can be divided in two main strands on the basis of the causative mechanism: iatrogenic cardiac damage due to cancer treatments toxicity and direct cardiac damage caused by the tumor itself In both conditions, cardiac biomarkers have been investigated for their potential predictive, diagnostic, monitoring and a prognostic role. The prediction of left ventricular dysfunction (LVD) caused by chemotherapy with high anthracycline doses and the diagnosis of cardiotoxicity in an early subclinical stage, i.e., when it is still undetectable with standard cardiovascular imaging methods, are i.e., when it isthe still undetectable with cardiovascular methods, are un-has undoubtedly clinical purposes forstandard which the employmentimaging of cardiac biomarkers doubtedly the clinical purposes for which the employment of cardiac biomarkers has been been most analysed in cardioncology to date. It is demonstrated that BNP and NTproBNP levels directly correlate to clinical outcomes in patients with HF [15,16]
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