Aims:

Cardio-oncology is a growing interdisciplinary field which aims to improve cardiological care for cancer patients supposing to reduce morbidity and mortality. We previously reported high-sensitive Troponin T (hs-TnT) stratifying cancer with a poor prognosis. We aimed to further validate this data and collected five years of experience in Heidelberg Cardio-Oncology outpatient clinics.

Methods:

Between 01/2016 to 12/2020 we collected data from 1971 patients with underlying oncological disease in the HEidelberg Cardio-Oncology REgistry (HEartCORE). Patients were admitted to the cardio-oncology unit at the University Hospital Heidelberg according to the current guidelines of the American Heart Association (AHA) and European Society of Cardiology (ESC). Every patient was examined by medical history, physical examination, 12-lead-ECG and 2D echocardiography including global longitudinal strain (GLS), if technical applicable. Additionally, cardiac biomarkers (high sensitive Troponin T (hs-cTnT) and N-terminal brain natriuretic peptide (NT-proBNP)) were assessed. Patients were administered usually before the begin of a new chemotherapy (1167, 59.2%).

Most patients were suffering from breast cancer (n = 852, 43.2%), upper gastrointestinal carcinoma (n = 206, 10.5%) or multiple myeloma (n = 118, 6.0%). At the initial visit, 85.6% of patients had a preserved left ventricular ejection fraction (LVEF >50%), at first follow up after three months (82.7%, Median 97.00 days [IQR 61.00, 147.00]) and the second follow up after six months (80.9%, Median another 90.00 days [IQR 57.00, 120.00]).

In this larger cohort confirmed our previous findings that hs-cTnT of ≥7 ng/L (multivariant logistic regression, OR: 1.77, p = 0.00034) and NT-proBNP (multivariant logistic regression, OR: 1,76, p = 0.00006) are independent predictors of ACM (all-cause mortality) among all included patients. In contrast, reduced LVEF was not significantly associated with increased ACM (multivariant analysis; p=0.13) but was so in the subgroup of Mamma carcinoma patients (multivariant logistic regression, OR: 2.81, p = <0.00025).

In the sub-cohort of breast cancer patients (n=852) hs-cTnT was a strong predictor for ACM in multivariant logistic regression (OR: 3.79, p = <0.00001), while NT-proBNP was highly significantly associated with ACM in non-breast cancer patients (multivariant logistic regression, OR: 1.86, p = 0.00086).

The presence of dyslipidemia was associated with increased hsTNT (logistic regression, OR: 2.36; p = <0.00001). While history of smoking was not associated with increased cardiac biomarkers or ACM (p=0.25).

Conclusions:

In our current cardio-oncological cohort hs-cTnT levels correlated with increased mortality at cutoff of 7 ng/L. In addition, NT-proBNP could serve as an additional biomarker for risk stratification in cancer patients. On top of that, we spotted a significant difference in sensitivity of available cardiac stratification tools regarding the tumour entity.

We conclude that measurement of cardiac biomarkers is an important tool to stratify the risk for mortality of cancer patients and more investigation is needed to determine entity specific spotlights for effective cardiac follow up.