Is Electrocardiogram Helpful in Predicting Positive Troponin I Due to Anthracycline Cardiotoxicity?

Abstract OBJECTIVEScreening patients on anthracycline-based chemotherapy regimens for the development of cardiotoxicity can be resource intensive. We therefore studied various traditional ECG parameters to correlate and possibly predict the development of positive Troponin I as a surrogate marker of anthracycline-induced cardiotoxicity.METHODSThis was a single centre prospective cohort study done between Januray 2014 to January 2016. Baseline ECG was compared with ECG done after chemotherapy and different parameters were compared. Patients were divided into Troponin I positve and negative groups based on the test performed at the end of chemotherapy using a cut-off of 0.06 ng/dL.RESULTSOf the 160 patients studied, 131 (81.9%) were Troponin I negative (TnI-) and 29 (18.1%) were positive (TnI+). Breast cancer accounted for 79% of all cancers in this study. Many ECG parameters where compared between TnI- and TnI+ groups. Of them, TP and TP/QT showed a significant decrease in the TnI+ group. The mean (95% CI) TP in TnI- group was 162.9 (145.4, 180.4) and in TnI+ groups was 117.9 (89, 146.8), p = 0.03. Corresponding values for TP/QT were 0.47 (0.42, 0.51) and 0.35 (0.27, 0.42), p = 0.02. These changes were not significant in multivariate analysis and likely reflected the different mean heart rates (HR) in both the groups as shown by Pearson’s partial correlation which was run with HR as confounder.CONCLUSIONSECG parameters like QTcH, TP and TP/QT are not helpful in predicting Troponin I elevations in patients on anthracycline-based chemotherapy. Further studies based on hard endpoints like clinical systolic dysfunction occuring at one year would give better information on their utility.