Cancer patients are high risk patients regarding morbidity and mortality due to their malignant disease, but also due to increased cardiovascular comorbidity. The impact of cardiac biomarkers, echocardiographic parameter and cardiological assessment regarding risk stratification is still unclear. We aimed to identify cardiac parameters that allow prediction of all-cause mortality (ACM) in cancer patients.

In this cohort study, we evaluated 930 patients that were admitted to the cardio-oncology outpatient clinic of the University Hospital Heidelberg from January 2016 to January 2019. We performed echocardiography, including Global Longitudinal Strain (GLS) analysis and measured cardiac biomarkers including N-terminal brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T levels (hs-cTnT).

Most patients were suffering from breast cancer (n=450, 48.4%), upper gastrointestinal carcinoma (n=99, 10.6%) or multiple myeloma (n=51, 5.5%). At the initial visit we observed 86.7% of patients having a preserved left ventricular ejection fraction (LVEF > 50%). At a second follow up, still 78.9% of patients showed a preserved LVEF. Echocardiographic parameters or elevation of NT-proBNP did not significantly correlate with ACM (logistic regression LVEF< 50%: p = 0.46, NT-proBNP: p=0.16) and failed to identify high-risk patients. In contrast, baseline hs-cTnT above the median (≥ 7 ng/l) was an independent marker to determine the risk of ACM (multivariant logistic regression, OR: 2.21, p=0.0038) among all included patients. Especially, hs-cTnT levels before start of a chemotherapy were predictive for ACM. Patients with an increase from below to above the 99^th percentile (14 ng/l) during follow-ups also showed increased mortality rates (logrank-test, p = 0.04).

Based on our non-selected cohort of cardio-oncological patients, hs-cTnT was able to identify patients with high mortality by using a low cutoff of 7ng/l. We conclude that measurement of hs-cTnT is an important tool to early stratify cancer patients for further cardio-oncological care.