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High-sensitivity cardiac troponin T determines all-cause mortality in cancer patients: a single-centre cohort study
Daniel Finke1,2, Sebastian W Romann1,2, Markus B Heckmann1,2
1Department of Internal Medicine III: Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
Insights
High-sensitivity cardiac troponin T (hs-cTnT) can identify cancer patients at high risk of all-cause mortality (ACM). Measuring hs-cTnT before chemotherapy helps stratify mortality risk in cardio-oncology patients.
Area of Science:
- Cardio-oncology
- Cardiovascular disease in cancer patients
- Biomarker research
Background:
- Cardio-oncology aims to improve cardiac care for cancer patients.
- Early risk stratification for cancer patients is crucial but challenging.
- The role of cardiac biomarkers and echocardiography in risk assessment needs clarification.
Purpose of the Study:
- To identify parameters for early risk stratification in cancer patients.
- To evaluate the impact of cardiac biomarkers and echocardiography on mortality risk.
Main Methods:
- A cohort study of 930 cardio-oncology patients (Jan 2016-Jan 2019).
- Echocardiography (including GLS) and cardiac biomarkers (NT-proBNP, hs-cTnT) were measured.
- Logistic regression analyzed correlations with all-cause mortality (ACM).
Main Results:
- Most patients had preserved left ventricular ejection fraction (>50%).
- Echocardiography and NT-proBNP did not significantly correlate with ACM.
- hs-cTnT levels ≥7 ng/L independently predicted ACM (OR: 2.21, P=0.0038).
- Pre-chemotherapy hs-cTnT levels were predictive of ACM.
Conclusions:
- hs-cTnT is a valuable tool for identifying high-mortality risk cancer patients.
- A low hs-cTnT cutoff (7 ng/L) effectively stratifies mortality risk.
- Measuring hs-cTnT before chemotherapy is recommended for risk assessment in cardio-oncology.
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.
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