Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy

Daniela Cardinale, Maria Teresa Sandri, Alessandro Martinoni, Alessio Tricca, Maurizio Civelli, Giuseppina Lamantia, Saverio Cinieri, Giovanni Martinelli, Carlo M. Cipolla, Cesare Fiorentini

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives. We investigated the role of cardiac troponin I (cTnI) in patients with aggressive malignancies treated with high-dose chemotherapy (HDC). Background. High dose chemotherapy is potentially limited by cardiac toxicity. Considering the fact that cardiac dysfunction may become clinically evident weeks or months after HDC, the availability of an early marker of myocardial injury, able to predict late ventricular impairment, is a current need. Methods. We measured, in 204 patients (45 ± 10 years) affected by cancer resistant to conventional treatment, the cTnI plasma concentration after every single cycle of HDC. According to the cTnI value (≤ or >0.4 ng/ml), patients were divided into a troponin positive (cTnI+, n = 65) and a troponin negative (cTnI-, n = 139) group. All patients underwent echocardiographic examination during the following seven months. Results. In the cTnI- group, left ventricular ejection fraction (LVEF) progressively decreased after HDC, reaching a maximal reduction after three months; however, myocardial depression was transient and no longer detectable at later follow-up. By contrast, in the cTnI+ group LVEF reduction was more marked and still evident at the end of the follow-up. In cTnI+ patients, a close relationship between the short-term cTnI increment and the greatest LVEF reduction was found (r = -0.87, p <0.0001). Conclusions. The elevation of cTnI in patients undergoing HDC for aggressive malignancies accurately predicts the development of future LVEF depression. In this setting, cTnI can be considered a sensitive and reliable marker of acute minor myocardial damage with relevant clinical and prognostic implications. (C) 2000 by the American College of Cardiology.

Original languageEnglish
Pages (from-to)517-522
Number of pages6
JournalJournal of the American College of Cardiology
Volume36
Issue number2
DOIs
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Nursing(all)

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