Table 1.
Role of cardiac troponins in the evaluation of chemotherapy and radiation-induced cardiotoxicity.
| Reference | Population | N | Treatment | Tn type | Cutoff | Troponin evaluations | Results and conclusions |
|---|---|---|---|---|---|---|---|
| Hugh-Davies et al. (64) | Breast cancer | 50 | ACs and RT | T | 0.1 ng/ml | Pre- and post-treatment | No change in TnT after 45–46 Gy delivered to the whole breast |
| Lipshultz et al. (65) | ALL | 15 | ACs | T | 0.03 ng/ml | Baseline, and 1–3 days after each cycle | Correlation between TnT and LV end-diastolic dimension and wall thickness |
| Herman et al. (59) | Animal study | 37 | ACs | T | Before, and 1 week after chemotherapy | TnT and histological myocardial changes in both related to cumulative doxorubicin dose | |
| Cardinale et al. (60) | Various | 204 | HDC | I | 0.5 ng/ml | Before, and 0, 12, 24, 36, and 72 h after every cycle | Elevated TnI during treatment predicted for LVEF decline |
| Cardinale et al. (61) | Breast cancer | 211 | HDC and RT | I | 0.5 ng/ml | Before, and 0, 12, 24, 36, and 72 h after every cycle | Correlation between max TnI, number of TnI positive assays, and max LVEF reduction |
| Auner et al. (66) | Hematologic malignancies | 78 | ACs | T | 0.03 ng/ml | Within 48 h of treatment start, then every 48 h during treatment | Correlation between TnT increase and median LVEF decline |
| Sandri et al. (63) | Various | 179 | HDC | I | 0.08 ng/ml | Before, and 0, 12, 24, 36, and 72 h after every cycle | TnI increase predicted subsequent LVEF decline |
| Cardinale et al. (62) | Various | 703 | HDC | I | 0.08 ng/ml | Before, and 0, 12, 24, 36, and 72 h after every cycle, and 1 month after treatment | Persistent TnI positivity predicted for subsequent LVEF decline |
| Kismet et al. (67) | Pediatric solid cancers | 24 | ACs | T | 0.01 ng/ml | With imaging, >1 month after chemo | No relationship between TnT and echocardiographic abnormalities |
| Lipshultz et al. (68) | ALL | 76 | ACs | T | 0.01 ng/ml | Throughout chemotherapy | TnT persistently increased during treatment, and predicted for cardioprotective response |
| Kilickap et al. (69) | Various | 41 | ACs | T | 0.01 ng/ml | Baseline, after first and last cycle | Correlation between TnT increase and diastolic dysfunction (E/A ratio) |
| Perik et al. (70) | Breast cancer | 17 | ACs and T | I | 0.1 g/l | Before, and throughout T therapy | No TnI elevations in 15/16 patients |
| Dodos et al. (71) | Various | 100 | ACs | T | 0.1 ng/ml | After first dose, last dose, and 1, 6, 12 months after last dose | No TnT elevations detected |
| Kozak et al. (72) | Lung and esophageal CA | 30 | ChemoRT | T | Baseline, 2 weeks after start of treatment and after | TnT undetectable in 29/30 patients | |
| Cil et al. (73) | Breast cancer | 33 | ACs | I | Before and after chemotherapy | No correlation between TnI and LVEF decline | |
| Mavinkurve-Groothuis et al. (74) | Various pediatric | 122 | ACs | T | 0.01 ng/ml | Once, with imaging | No patients with elevated TnT levels |
| Cardinale et al. (75) | Breast cancer | 251 | ACs and T | I | 0.08 ng/ml | Before T, every 3 months during treatment, 1 year after start, every 6 months | Elevated TnI values are an independent predictor of cardiotoxicity, and LVEF recovery |
| Nellessen et al. (76) | Lung and breast CA | 23 | RT | I | 0.03 ng/ml | Before RT, every week during RT for 4–6 weeks | Log-transformed TnI increased during treatment |
| Fallah-Rad et al. (51) | Breast cancer | 42 | ACs and T | T | Before chemotherapy, before T, and 3, 6, 9, and 12 months after start of T | No change in TnT values over time | |
| Feola et al. (77) | Breast cancer | 53 | ACs | I | 0.03 ng/ml | Baseline, after 1 month, 1, and 2 years | TnI concentrations elevated at 1 month, then returned to normal |
| Goel et al. (78) | Breast cancer | 36 | ACs and T | I | 0.20 ng/ml | Baseline, before and 24 h after T | No elevated TnI values throughout |
| Morris et al. (79) | Breast cancer | 95 | ACs and T | I | 0.04–0.06 ng/ml | Every 2 weeks during treatment, then at 6, 9, and 18 months | Elevated TnI values preceded maximal LVEF decline, but no relationship with max LVEF decline |
| Romano et al. (80) | Breast cancer | 92 | ACs | I | 5 or 0.08 ng/ml (age ≤50 or >50) | Every 2 weeks during treatment, then at 3, 6, and 12 months | No correlation between TnI change and subsequent LV impairment |
| Sawaya et al. (81) | Breast cancer | 43 | ACs and T | I | 0.015 ng/ml | Baseline, 3 and 6 months after chemotherapy | Elevated TnI at 3 months predicted for cardiotoxicity within 6 months |
| D’Errico et al. (82) | Breast cancer | 60 | ChemoRT | I | 0.07 ng/ml | Before, and after RT | No elevated TnI concentrations |
| Garrone et al. (83) | Breast cancer | 50 | ACs | I | 0.03 ng/ml | Baseline, 5, 16, and 28 months after | TnI kinetics correlated with LVEF decline |
| Lipshultz et al. (84) | ALL | 156 | ACs | T | 0.01 ng/ml | Before, and daily during induction, and after treatment | Lower incidence of detectable TnT during treatment with dexrazoxane |
| Onitilo et al. (85) | Breast cancer | 54 | Taxanes and T | I | 0.1 ng/ml | Baseline, and every 3 weeks during treatment | TnI undetectable throughout |
| Sawaya et al. (86) | Breast cancer | 81 | ACs and T | I | 30 pg/ml | Before, every 3 months during, and after T treatment | Elevated TnI values at end of treatment predictive of subsequent cardiotoxicity |
| Sherief et al. (87) | Acute leukemias | 50 | ACs | T | 0.01 ng/ml | Once, with imaging | No elevated TnT values |
| Erven et al. (88) | Breast cancer | 72 | RT | I | 0.13 ng/ml | Before and after RT | Higher TnI values in L-sided breast patients |
| Ky et al. (89) | Breast cancer | 78 | ACs and T | I | 121.8 ng/ml | Baseline, 3 and 6 months after start of chemotherapy | Interval change in TnI predicted cardiotoxicity |
Tn, troponin; AC, anthracycline; RT, radiation therapy; HDC, high-dose chemotherapy; T, trastuzumab; LVEF, left ventricular ejection fraction; ALL, acute lymphoblastic leukemia.