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. 2022 Dec:27:440-454.
doi: 10.33145/2304-8336-2022-27-440-454.

CARDIOTOXICITY IN BREAST CANCER PATIENTS: RELATIONSHIP OF HS-TROPONIN T CHANGES AND HEART FUNCTION IN CANCER TREATMENT

[Article in English, Ukrainian]
N V Dovganych  1 , S M Kozhukhov  1 , I I Smolanka  2 , O F Lygyrda  2 , O Ye Bazyka  1 , S A Lyalkin  2 , O M Ivankova  2 , O A Yarynkina  1 , N V Tkhor  1
Affiliations

CARDIOTOXICITY IN BREAST CANCER PATIENTS: RELATIONSHIP OF HS-TROPONIN T CHANGES AND HEART FUNCTION IN CANCER TREATMENT

[Article in English, Ukrainian]
N V Dovganych et al. Probl Radiac Med Radiobiol. 2022 Dec.

Abstract
in English, Ukrainian

Breast cancer patients (BC) have a high risk of cardiotoxicity (CT) due to a combination of cancer treatments.Cardiovascular (CV) complications lead to delay or withdrawal of BC therapy and worsen the survival. Therefore, it isimportant to detect CT at the early stages before the occurrence of cardiac dysfunction and heart failure (HF) signs.

Objective: to study the dynamic changes of high-sensitivity (hs) troponin (Tn) T (hs-TnT) level in BC patients during cancer treatment with the use of chemotherapy and radiation therapy (RT) to predict and prevent CV complications during individualized management.

Material and methods: 40 BC patients were included in the pilot study. The analysis of the dynamic changes of hs-TnT and ejection fraction (EF) of the left ventricle (LV) was performed before and within 6 months of cancer treatment. Based on the data analysis, a definition of a significant increase in hs-TnT was developed and proposed. Therise of hs-TnT was calculated by the difference (%) between its baseline level and in the 6 months of cancer treatment. BC patients are grouped into tertiles according to the hs-TnT increase: group 1 - low level (0-50 %), group 2 -moderate level (> 50-100 %), and group 3 - high level (> 100 %).

Results: Before the start of cancer treatment, LVEF did not differ significantly between groups (mean EF (62.6 ± 1.0) %)and the hs-TnT level was also within normal values (0.008±0.001 ng/ml). In 6 months of cancer treatment, LVEF waswithin the normal ranges and did not differ significantly in patients of group 1. However, in patients of groups 2and 3 - LVEF drop (δLV EF) was 5.7 % (р < 0.01) and 10.8 % (р < 0.01), consequently. According to the correlationanalysis, the percentage of increase in hs-TnT (δhs-TnT) was associated with δEF LV (r = 0.39, р < 0.05) and the useof anthracyclines (AC) (r = 0.37, р < 0.05). Using logistic regression and ROC analysis, the diagnostic threshold valueof the hs-TnT increase > 165 % was defined, which can be considered as a reliable marker of early biochemical CT,with a sensitivity of 99 % and a specificity of 56 %.

Conclusions: In BC patients, based on the level of hs-TnT increase, proposed a new early biochemical CT detectionmethod. Under the new approach, BC patients with hsTnT increase of > 165 % from baseline can be considered as areliable marker of early biochemical CT, with a sensitivity of 99 % and a specificity of 56 %.

Khvori na rak grudnoï zalozy (RGZ), z ogliadu na kombinovanu protypukhlynnu terapiiu (PPT), maiut' vysokyĭ ryzykkardiotoksychnosti (KT). Uskladnennia pryzvodiat' do vidterminuvannia chy zupynky PPT. Tse pogirshuie vyzhyvanniakhvorykh z RGZ. Tomu vazhlyvo vyiavliaty KT na rannikh stadiiakh, koly shche nemaie porushen' funktsiï sertsia ta oznak sertsevoï nedostatnosti (SN).Meta: vyvchyty zminy vysokochutlyvogo (vch) troponinu (Tn) T (vchTnT) u khvorykh na RGZ pry provedeni PPT z vykorystanniam khimioterapiï (KhT) ta promenevoï terapiï (PT) z metoiu prognozuvannia ta profilaktyky sertsevo-sudynnykh (SS) uskladnen' v protsesi indyvidualizovanogo vedennia khvorykh na RGZ.Material i metody. V pilotne doslidzhennia vkliucheno 40 khvorykh na RGZ, v iakykh provedeno analiz dynamiky vchTnTta fraktsiï vykydu (FV) livogo shlunochka (LSh) do pochatku PPT ta v termin 6 mis. Na osnovi analizu danykh bulorozrobleno ta zaproponovano vyznachennia znachushchogo pidvyshchennia vchTnT, iaka vrakhovuie riznytsiu (u vidsotkakh) mizhĭogo bazovym rivnem ta v period 6 mis. Patsiienty buly rozpodileni na grupy za stupenem pidvyshchennia vch TnT:1-sha grupa – nyz'kyĭ riven' pidvyshchennia (0–50 %), 2-ga grupa – pomirnyĭ riven' (> 50–100 %), 3-tia grupa – vysokyĭ riven' pidvyshchennia ( > 100%). Rezul'taty. Do pochatku provedennia PPT FV LSh dostovirno ne vidriznialas' mizh grupamy i v seredn'omu skladala (62,6 ± 1,0) %. Riven' TnT takozh znakhodyvsia v mezhakh normal'nykh velychyn, i skladav (0.008 ± 0,001) ng/ml.Pry dynamichnomu sposterezhenni v termin 6 mis. vid pochatku PPT u khvorykh 1-ï grupy FV LSh bula v mezhakh normyta dostovirno ne vidriznialas', u khvorykh 2-ï grupy velychyna znyzhennia (δ) FV skladala (5,7 ± 0,9) % (r < 0,01),a u khvorykh 3-ï grupy – 10,8 % (r < 0,01). Za danymy koreliatsiĭnogo analizu, vidsotok (δ) zbil'shennia vchTnT buvdostovirno pov’iazanyĭ z δFV LSh (r = 0,39, r < 0,05), ta vykorystanniam antratsyklinovykh antybiotykiv (r = 0,37,r < 0,05). Vykorystovuiuchy logistychnu regresiiu ta ROC analiz, bulo vyznacheno porogove znachennia vchTnT > 165 %,shcho mozhe rozgliadatysia iak marker rann'oï biokhimichnoï KT, z chutlyvistiu 99 % ta spetsyfichnistiu 56 %.Vysnovky. Rozrobleno metodyku vyznachennia stupenia pidvyshchennia rivnia Tn, u vidpovidnosti z iakoiu mozhna prognozuvaty rozvytok KT u khvorykh na RGZ. Zgidno iz zaproponovanoiu formuloiu khvori, iaki maiut' pidvyshchenniavchTnT > 165 %, maiut' oznaky rann'oï biokhimichnoï KT i ie patsiientamy vysokogo ryzyku KT uskladnen'.

Keywords: breast cancer; cardiotoxicity; heart failure; heart function; troponin T.

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