Prediction of anthracycline-induced left ventricular dysfunction by cardiac troponins

Evidence suggests prognostic utility of troponin (Tn) serum concentrations for a variety of conditions. We sought to determine whether elevated concentrations early after anthracycline chemotherapy predict the development of left ventricular systolic dysfunction in adult patients with cancer. PubMed/MEDLINE searches identified original reports that assessed cardiac TnI or TnT within 5 days of anthracycline chemotherapy and evaluated left ventricular systolic function after treatment for review. Ten reports qualified for review. Four studies indicated a significant relation between elevated Tn and subsequent left ventricular systolic dysfunction. One study that enrolled patients actively receiving anthracyclines and others who had previously received anthracyclines also demonstrated a significant relation. The remaining five reports identified no such relation. Heterogeneity in experimental methods, sampling times, and handling of confounders was significant between positive and negative studies. The present evidence is insufficient to suggest that Tns are reliable predictors of left ventricular dysfunction in patients with cancer. These data suggest, however, that larger prospective studies using frequent scheduled Tn measurement with adjustment for confounding factors could determine the predictive value of Tns in this setting.