Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction
Background We examined the longitudinal associations between changes in cardiovascular biomarkers and cancer therapy–related cardiac dysfunction (CTRCD) in patients with breast cancer treated with cardotoxic cancer therapy. Methods and Results Repeated measures of high‐sensitivity cardiac troponin T...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014708 |
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| author | Biniyam G. Demissei Rebecca A. Hubbard Liyong Zhang Amanda M. Smith Karyn Sheline Caitlin McDonald Vivek Narayan Susan M. Domchek Angela DeMichele Payal Shah Amy S. Clark Kevin Fox Jennifer Matro Angela R. Bradbury Hayley Knollman Kelly D. Getz Saro H. Armenian James L. Januzzi W. H. Wilson Tang Peter Liu Bonnie Ky |
| author_facet | Biniyam G. Demissei Rebecca A. Hubbard Liyong Zhang Amanda M. Smith Karyn Sheline Caitlin McDonald Vivek Narayan Susan M. Domchek Angela DeMichele Payal Shah Amy S. Clark Kevin Fox Jennifer Matro Angela R. Bradbury Hayley Knollman Kelly D. Getz Saro H. Armenian James L. Januzzi W. H. Wilson Tang Peter Liu Bonnie Ky |
| author_sort | Biniyam G. Demissei |
| collection | DOAJ |
| description | Background We examined the longitudinal associations between changes in cardiovascular biomarkers and cancer therapy–related cardiac dysfunction (CTRCD) in patients with breast cancer treated with cardotoxic cancer therapy. Methods and Results Repeated measures of high‐sensitivity cardiac troponin T (hs‐cTnT), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), myeloperoxidase, placental growth factor, and growth differentiation factor 15 were assessed longitudinally in a prospective cohort of 323 patients treated with anthracyclines and/or trastuzumab followed over a maximum of 3.7 years with serial echocardiograms. CTRCD was defined as a ≥10% decline in left ventricular ejection fraction to a value <50%. Associations between changes in biomarkers and left ventricular ejection fraction were evaluated in repeated‐measures linear regression models. Cox regression models assessed the associations between biomarkers and CTRCD. Early increases in all biomarkers occurred with anthracycline‐based regimens. hs‐cTnT levels >14 ng/L at anthracycline completion were associated with a 2‐fold increased CTRCD risk (hazard ratio, 2.01; 95% CI, 1.00–4.06). There was a modest association between changes in NT‐proBNP and left ventricular ejection fraction in the overall cohort; this was most pronounced with sequential anthracycline and trastuzumab (1.1% left ventricular ejection fraction decline [95% CI, −1.8 to –0.4] with each NT‐proBNP doubling). Increases in NT‐proBNP were also associated with CTRCD (hazard ratio per doubling, 1.56; 95% CI, 1.32–1.84). Increases in myeloperoxidase were associated with CTRCD in patients who received sequential anthracycline and trastuzumab (hazard ratio per doubling, 1.28; 95% CI, 1.04–1.58). Conclusions Cardiovascular biomarkers may play an important role in CTRCD risk prediction in patients with breast cancer who receive cardiotoxic cancer therapy, particularly in those treated with sequential anthracycline and trastuzumab therapy. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01173341. |
| first_indexed | 2024-04-12T23:30:12Z |
| format | Article |
| id | doaj.art-3129ac19a1da4bdd9e07e350ceaf8c0a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T23:30:12Z |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-3129ac19a1da4bdd9e07e350ceaf8c0a2022-12-22T03:12:17ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-01-019210.1161/JAHA.119.014708Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac DysfunctionBiniyam G. Demissei0Rebecca A. Hubbard1Liyong Zhang2Amanda M. Smith3Karyn Sheline4Caitlin McDonald5Vivek Narayan6Susan M. Domchek7Angela DeMichele8Payal Shah9Amy S. Clark10Kevin Fox11Jennifer Matro12Angela R. Bradbury13Hayley Knollman14Kelly D. Getz15Saro H. Armenian16James L. Januzzi17W. H. Wilson Tang18Peter Liu19Bonnie Ky20Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PADepartment of Biostatistics, Epidemiology & Informatics Perelman School of Medicine at the University of Pennsylvania Philadelphia PADivision of Cardiology University of Ottawa Heart Institute Ottawa Ontario CanadaDepartment of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PADepartment of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PADepartment of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PAAbramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PADivision of Oncology The Children's Hospital of Philadelphia PADepartment of Population Sciences City of Hope Duarte CADivision of Cardiovascular Medicine Massachusetts General Hospital Boston MADivision of Cardiovascular Medicine Cleveland Clinic Cleveland OHDivision of Cardiology University of Ottawa Heart Institute Ottawa Ontario CanadaDepartment of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PABackground We examined the longitudinal associations between changes in cardiovascular biomarkers and cancer therapy–related cardiac dysfunction (CTRCD) in patients with breast cancer treated with cardotoxic cancer therapy. Methods and Results Repeated measures of high‐sensitivity cardiac troponin T (hs‐cTnT), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), myeloperoxidase, placental growth factor, and growth differentiation factor 15 were assessed longitudinally in a prospective cohort of 323 patients treated with anthracyclines and/or trastuzumab followed over a maximum of 3.7 years with serial echocardiograms. CTRCD was defined as a ≥10% decline in left ventricular ejection fraction to a value <50%. Associations between changes in biomarkers and left ventricular ejection fraction were evaluated in repeated‐measures linear regression models. Cox regression models assessed the associations between biomarkers and CTRCD. Early increases in all biomarkers occurred with anthracycline‐based regimens. hs‐cTnT levels >14 ng/L at anthracycline completion were associated with a 2‐fold increased CTRCD risk (hazard ratio, 2.01; 95% CI, 1.00–4.06). There was a modest association between changes in NT‐proBNP and left ventricular ejection fraction in the overall cohort; this was most pronounced with sequential anthracycline and trastuzumab (1.1% left ventricular ejection fraction decline [95% CI, −1.8 to –0.4] with each NT‐proBNP doubling). Increases in NT‐proBNP were also associated with CTRCD (hazard ratio per doubling, 1.56; 95% CI, 1.32–1.84). Increases in myeloperoxidase were associated with CTRCD in patients who received sequential anthracycline and trastuzumab (hazard ratio per doubling, 1.28; 95% CI, 1.04–1.58). Conclusions Cardiovascular biomarkers may play an important role in CTRCD risk prediction in patients with breast cancer who receive cardiotoxic cancer therapy, particularly in those treated with sequential anthracycline and trastuzumab therapy. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01173341.https://www.ahajournals.org/doi/10.1161/JAHA.119.014708biomarkercardiomyopathycardio‐oncologycardiotoxicity |
| spellingShingle | Biniyam G. Demissei Rebecca A. Hubbard Liyong Zhang Amanda M. Smith Karyn Sheline Caitlin McDonald Vivek Narayan Susan M. Domchek Angela DeMichele Payal Shah Amy S. Clark Kevin Fox Jennifer Matro Angela R. Bradbury Hayley Knollman Kelly D. Getz Saro H. Armenian James L. Januzzi W. H. Wilson Tang Peter Liu Bonnie Ky Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease biomarker cardiomyopathy cardio‐oncology cardiotoxicity |
| title | Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction |
| title_full | Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction |
| title_fullStr | Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction |
| title_full_unstemmed | Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction |
| title_short | Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction |
| title_sort | changes in cardiovascular biomarkers with breast cancer therapy and associations with cardiac dysfunction |
| topic | biomarker cardiomyopathy cardio‐oncology cardiotoxicity |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014708 |
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