The Role of Biomarkers to Evaluate Cardiotoxicity
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Cardio-oncology (MG Fradley, Section Editor)
The Role of Biomarkers to Evaluate Cardiotoxicity Jenica N. Upshaw, MD, MS Address Division of Cardiology, Tufts Medical Center, 800 Washington St, Box 5931, Boston, MA, 02111, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Cardio-oncology Keywords Cardio-oncology I Biomarkers I Heart failure I Chemotherapy I Anthracyclines I Radiation I Cardiovascular disease
Opinion statement Moderate-level evidence suggests that cardiac troponin and natriuretic peptides are useful for risk stratification and early identification of anthracycline cardiotoxicity; however, many of these studies used older chemotherapy regimens, and thus, the applicability to current anthracycline treatment regimens is uncertain. Further research is needed to determine optimal timing and thresholds for troponin and natriuretic peptides in anthracycline-treated patients and evaluate these and other promising biomarkers for anti-HER2 therapies, thoracic radiation, anti-VEGF therapy, and fluoropyrimidine therapy– related cardiotoxicity. Risk tools that combine cardiac risk factors, cancer treatment variables, biomarkers, and imaging parameters are most likely to accurately identify individuals at highest risk for cancer therapy cardiotoxicity. Clinical trials focusing cardioprotective strategies on high-risk individuals are more likely to result in clinically significant results compared with primary prevention cardioprotective approaches.
Introduction Advances in early detection and treatment have reduced cancer-specific mortality for many cancers [1]. In 2016, there were more than 16 million cancer survivors in the USA, and this number is expected to increase to approximately 26 million in 2040 [2]. Compared with age- and gender-matched controls, cancer survivors are at increased risk for common cardiovascular conditions such heart failure (HF), myocardial infarction, stroke,
arrhythmias, and valvular disease [3–5]. The cardiovascular toxicity of cancer treatment as well as prevalent comorbid cardiovascular risk factors contributes to excess cardiovascular events in patients with cancer. Biomarkers such as cardiac troponin and natriuretic peptides are used routinely in cardiovascular medicine for diagnosis and risk stratification. Serum biomarkers can assist with early detection and diagnosis of disease and
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improve understanding of disease pathophysiology. This review summarizes the current evidence regarding
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biomarkers for the detection of cardiovascular toxicity during and after cancer therapy.
Anthracycline cardiotoxicity Anthracycline chemotherapeutic agents can lead to cardiomyopathy and clinical HF. Anthracyclines interact with topoisomerase 2b causing oxidative and nitrosative stress, double-stranded DNA breaks, mitochondrial dysfunction, and apoptosis [6–8]. While the use of anthracyclines is declining to some ext
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