Investigation of biomarker-based follow-up of anthracycline-induced cardiotoxicity in patients with breast cancer based on the latest protocol from the European Society of Cardiology guideline on cardio-oncology

Background: Anthracyclines are commonly used for the treatment of solid tumors and hematological malignancies because of their inevitable dose-dependent cardiotoxic effects. The study aimed to assess the feasibility of applying a biomarker-based surveillance strategy according to European guidelines for the early prediction of anthracycline-induced cardiotoxicity in patients with breast cancer. Methods: From April 2018 to December 2021, 45 women with breast cancer (53.9 ± 11.0 years) treated with anthracycline-based regimens were evaluated for 1 year. We measured and analyzed high-sensitivity cardiac troponin T (hsTnT), B-type natriuretic peptide (BNP), global longitudinal strain (GLS), and left ventricular ejection fraction (LVEF) at baseline, and 3 and 6 months after the initiation of anthracycline-based chemotherapy. Cardiotoxicity was defined as a reduction in LVEF > 10% compared with baseline to LVEF  15% from baseline. Results: After initiating anthracycline treatment, hsTnT levels peaked at 3 months, whereas BNP levels were the highest at 6 months. Cardiotoxicity was detected in 18 (20.0%) patients (one patient with LVEF decline), where GLS declined over time yet became significant only after 6 months. Elevated hsTnT at 3 months were significantly associated with a GLS decline at 6 months (P < 0.001, Youden index 0.009 g/mL increase from baseline; sensitivity and specificity were 100% and 80.5%, respectively). In contrast, changes in BNP were not associated with changes in LVEF or GLS. No symptomatic heart failure occurred within 1 year of chemotherapy. Conclusions: Among patients with early-stage breast cancer, an increase in hsTnT at 3 months after initiation of the anthracycline-based regimen predicted a subsequent decline in GLS with high sensitivity and moderate specificity.