Background

Cancer patients are at risk for the presence of cardiovascular disease (coronary artery disease, hypertension or heart failure). 

Aim

Aim of the study was to evaluate the impact of elevated cardiac biomarker on the presence of coronary artery disease (CAD) in cancer patients.

Methods

Patients admitted to the cardio-oncology unit at the University Hospital Heidelberg between 2016 and 2023 were evaluated by medical history, physical examination, 12-lead-ECG, 2D-echocardiography and cardiac biomarkers (high-sensitive cardiac Troponin T (hs-cTnT); N-terminal brain natriuretic peptide (NT-proBNP)). All eligible patients’ cases with hs-cTnT level of 14 ng/l or more were analyzed. 

Results

From 3300 cardio-oncological patients, 1035 patients presented with an asymptomatic hs-cTnT-elevation ≥14ng/l [median:  21ng/l, IQR 16-32 ng/l]. 488/1035 patients were not further evaluated for the presence of CAD based on comorbidities or alternative explanation for elevated cardiac biomarker. 

547 patients were evaluated for the presence of CAD by either by stress testing (cardiac MRI or stress echocardiography; n=146), computer tomography (n=70) or cardiac catheterization (n=274). Presence of CAD was diagnosed in 437/1035 patients (42.2%). 249 patients presented with known CAD and 188/1035 patients (18.16%) were newly diagnosed with CAD within a median of 20 days [IQR 6, 86] after presentation. Significant stenosis followed by percutaneous coronary intervention (PCI) was identified in 62 patients.  Within the observation period, 459 patients (44.3%) died in median 471 [IQR 197-865] days after presentation.

Elevated hs-cTnT correlated significantly with the presence of coronary artery disease (OR 3.75, p<0.001). Moreover, presence of CAD was independently associated with reduced LVEF (OR 4.23, p<0.001), arterial hypertension (OR 2.43, p<0.001), Diabetes (OR 1.45, p=0.039) and smoking (OR 1.33, p=0.048). New diagnosis of CAD correlated significantly only with a reduced LVEF (OR 2.38, p<0.001) and elevated first hs-TnT (OR 2,47, p<0.001).

Conclusions: 

In cancer patients, increased cardiac biomarkers and cardiac risk factors associate with the presence of CAD. CAD should be considered in asymptomatic oncological patients with elevated cardiac biomarkers. 

Keywords

Cardio-oncology, Coronary arterial disease, Cardiac Biomarkers, Coronary heart disease, Heart failure, Cardiotoxicity, Cancer survivors, risk stratification