Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues
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CARDIO-ONCOLOGY (EH YANG, SECTION EDITOR)
Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues Valentina Bracun 1 & Joseph Pierre Aboumsallem 1 & Peter van der Meer 1 & Rudolf A. de Boer 1
# The Author(s) 2020
Abstract Purpose of the Review As the number of cancer survivors increases due to early screening and modern (antineoplastic) treatments, cancer treatment associated cardiotoxicity (CTAC) is becoming an increasing health burden that affects survival and quality of life among cancer survivors. Thus, clinicians need to identify adverse events early, in an effort to take suitable measures before the occurrence of permanent or irreversible cardiac dysfunction. Recent Findings Cardiac troponin (cTn) and B-type natriuretic peptide (BNP) have been proven to detect subclinical cardiotoxicity during antineoplastic treatment. As such, these cardio-specific biomarkers could predict which patients are at risk of developing CTAC even before the start of therapy. Nevertheless, there are inconsistent data from published studies, and the recommendations regarding the use of these biomarkers and their validity are mostly based on expert consensus opinion. Summary In this review, we summarize available literature that evaluates biomarkers of CTAC, and we encourage strategies that integrate circulating biomarkers and cardiac imaging in identifying cancer patients that are at high risk. Keywords Biomarkers . Chemotherapy . Cardiotoxicity . Heart failure . Cardio-oncology
Introduction Now that efforts to prevent cardiovascular disease (CVD) have improved outcomes, cancer is rising as the major cause of mortality and morbidity in high-income countries [1]. According to the World Health Organization, Europe, which represents 9% of the global population, accounts for 23.4% of the global cancer cases and 20.3% of global cancer deaths. There are approximately 8.7 million cancer survivors in Europe, [2] and more This article is part of the Topical Collection on Cardio-oncology * Rudolf A. de Boer [email protected] Valentina Bracun [email protected] Joseph Pierre Aboumsallem [email protected] Peter van der Meer [email protected] 1
Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
than 3 million new cases are predicted to occur every year [3]. The Americans come in the second place with 21% and 14.4% of the global incidence and mortality, respectively [4]. According to the American Cancer Society, around 17 million Americans have a history of cancer and the number of cancer survivors is expected to increase to more than 22.1 million in 2030 [5]. Furthermore, cancer and CVD share multiple risk factors and in fact very often coincide [6, 7]. In the last years, cancer management and treatments have improved. However, the use of both traditional and novel antineoplastic agents is limited by their toxic effects, often leading to CTAC. Previously, the risk of CTAC was not recognized bec
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