Aims:

Oncological patients suspected to have the risk for cardiotoxicity, are recommended to be under intensified cardiological surveillance. We aimed to investigate the value of cardiac biomarker and patient-related risk factors (age, cardiovascular risk factors (CRF), cardiac function) for the prediction of all-cause mortality (ACM) and development of cardiotoxicity.

Methods:

Between 01/2016 to 12/2020, patients with oncological diseases, admitted to the cardio-oncology unit at the University Hospital Heidelberg were included. They were examined by medical history, physical examination, 12-lead-ECG, 2D-echocardiography and cardiac biomarkers (high sensitive Troponin T (hs-cTnT); N-terminal brain natriuretic peptide (NT-proBNP)). Primary endpoint was defined as ACM, secondary endpoint was defined as cardiotoxicity as defined by the European Society of Cardiology.

Results

From 1971 included patients, primary endpoint was reached by 490 patients (25.7%) with a median of 363.5 [IQR 121.8, 522.5] days after presentation. Hs-cTnT of ≥7 ng/L (OR 2.27, p<0.001) and NT-proBNP (OR 2.12, p<0.001) were independent predictors of ACM, while reduced LVEF was not associated with increased ACM (p=0.78; OR1.04). Secondary endpoint was reached by 182 patients (9.2%) within a median of 793.5 days [IQR 411.2, 1165.0]. Patients with multiple CRF (defined as high-risk, n=886) had an increased risk for cardiotoxicity (n=100/886, 11.3%; HR 1.57, p=0.004). They showed increased baseline values of hs-cTnT (OR 1.60; p=0.006) and NT-proBNP (OR 4.00, p<0.001) and had an increased risk for ACM (OR 1.43; p=0.031).

Conclusions:

In cancer patients, accumulation of CRF predestine for cardiotoxicity while increased hs-cTnT levels and NT-proBNP associate with ACM.  Therefore, less intense surveillance protocols might be justified in patients with low values of cardiac biomarker and absence of CRF.

Keywords