Assessment of cardiotoxicity in cancer patients on chemotherapy in a low resource setting: is echocardiography the ultimate tool, or should we look for another?

Submitted: 12 March 2024
Accepted: 13 June 2024
Published: 28 June 2024
Abstract Views: 83
PDF: 39
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Cancer is a leading cause of death worldwide, and its burden in Africa is projected to rise. Africans have cause to worry over what to do to reduce its morbidity and mortality. Unfortunately, some of the most effective anticancer therapies cause cardiovascular dysfunction and may deny patients with cancer the life-saving benefits of chemotherapy Currently, expert consensus opinion adopts echocardiography to define cancer chemotherapy-induced cardiotoxicity, but the cost is unaffordable in most low-income countries. This review aims to examine the use of Cardiac Troponin (cT) to detect cardiotoxicity, particularly early cardiotoxicity, which routine echo is unable to do. We propose that patients on cancer chemotherapy should first have a cT assessment, and depending on the level of the cT, an echo may be indicated. This will reduce the frequency and cost of echo. Our proposal may also lead to a new definition of cancer chemotherapy-induced cardiotoxicity, taking into consideration the usefulness of cT.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Breasted JH. The Edwin Smith Surgical Papyrus. University of Chicago Press; Chicago, USA; 1930. DOI: https://doi.org/10.1515/9783112615263-011
Sanchez GM, Meltzer ES. The Edwin Smith Papyrus: updated translation of the trauma treatise and modern medical commentaries. Lockwood Press; Atlanta, USA; 2012.
International Agency for Research on Cancer. Global Cancer Observatory: cancer today. 2020. Available from: https://gco.iarc.fr/today/en
Sharma R, Nanda A, Fronterre C, et al. Mapping cancer in Africa: a comprehensive and comparable characterization of 34 cancer types using estimates from GLOBOCAN 2020. Front Public Health 2022;10:839835. DOI: https://doi.org/10.3389/fpubh.2022.839835
Falzone L, Salomone S, Libra M. Evolution of cancer pharmacological treatments at the turn of the third millennium. Front Pharmacol 2018;9:1300. DOI: https://doi.org/10.3389/fphar.2018.01300
Khouri MG, Douglas PS, Mackey JR. Cancer therapy-induced cardiac toxicity in early breast cancer: addressing the unresolved issues. Circulation 2012;126:2749-63. DOI: https://doi.org/10.1161/CIRCULATIONAHA.112.100560
European Society for Medical Oncology (ESMO). Guidelines Methodology. 2022. Available from: https://www. esmo.org/Guidelines/ESMO-Guidelines-Methodology
Zamorano JL, Lancellotti P, Rodriguez Munoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. European Heart Journal 2016;37:2768-801. DOI: https://doi.org/10.1093/eurheartj/ehw211
Adhikari A, Asdaq SMB, Al Hawaj MA, et al. anticancer drug-induced cardiotoxicity: insights and pharmacogenetics. Pharmaceuticals 2021;14:970. DOI: https://doi.org/10.3390/ph14100970
Von Hoff DD, Layard MW, Basa P, et al. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med 1979;91:710-7. DOI: https://doi.org/10.7326/0003-4819-91-5-710
Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 2003;97:2869-79. DOI: https://doi.org/10.1002/cncr.11407
Jensen BV, Skovsgaard T, Nielsen SL. Functional monitoring of anthracycline cardiotoxicity: a prospective, blinded, long-term observational study of outcome in 120 patients. Ann Oncol 2002;13:699-709. DOI: https://doi.org/10.1093/annonc/mdf132
Billingham ME, Mason JW, Bristow MR, Daniels JR. Anthracycline cardiomyopathy monitored by morphologic changes. Cancer Treat Rep 1978;62:865-72.
Mackay B, Ewer MS, Carrasco CH, Benjamin RS. Assessment of anthracycline cardiomyopathy by endomyocardial biopsy. Ultrastruct Pathol 1994;18:203-11. DOI: https://doi.org/10.3109/01913129409016291
Ewer MS, Ewer SM. Cardiotoxicity of anticancer treatments. Nat Rev Cardiol 2015;12:620. DOI: https://doi.org/10.1038/nrcardio.2015.133
Johnson DB, Balko JM, Compton ML, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med 2016;375:1749-55. DOI: https://doi.org/10.1056/NEJMoa1609214
Ewer MS, Lippman SM. Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity. J Clin Oncol 2005;23:2900-2. DOI: https://doi.org/10.1200/JCO.2005.05.827
Jain D, Aronow W. Cardiotoxicity of cancer chemotherapy in clinical practice. Hospital Practice 2019;47:6-15. DOI: https://doi.org/10.1080/21548331.2018.1530831
Tan C, Tasaka H, Yu KP, et al. Daunomycin, an antitumor antibiotic, in the treatment of neoplastic disease. Clinical evaluation with special reference to childhood leukemia. Cancer 1967;20:333-53. DOI: https://doi.org/10.1002/1097-0142(1967)20:3<333::AID-CNCR2820200302>3.0.CO;2-K
Alexander J, Dainiak N, Berger HJ, et al. Serial assessment of doxorubicin cardiotoxicity with quantitative radionuclide angiocardiography. N Engl J Med 1979;300:278-83 DOI: https://doi.org/10.1056/NEJM197902083000603
Lenzhofer R, Dudczak R, Gumhold G, et al. Noninvasive methods for the early detection of doxorubicin-induced cardiomyopathy. J Cancer Res Clin Oncol 1983;106:136-42. DOI: https://doi.org/10.1007/BF00395392
Ramos A, Meyer RA, Korfhagen J, et al. Echocardiographic evaluation of adriamycin cardiotoxicity in children. Cancer Treat Rep 1976;60:1281-4.
Ewer MS, Ali MK, Mackay B, et al. A comparison of cardiac biopsy grades and ejection fraction estimations in patients receiving adriamycin. J Clin Oncol 1984;2:112-7. DOI: https://doi.org/10.1200/JCO.1984.2.2.112
Neilan TG, Jassal DS, Perez-Sanz TM, et al. Tissue Doppler imaging predicts left ventricular dysfunction and mortality in a murine model of cardiac injury. Eur Heart J 2006;27:1868-75. DOI: https://doi.org/10.1093/eurheartj/ehl013
Sechtem U, Neubauer S, Revel D, et al. The clinical role of magnetic resonance in cardiovascular disease. Task force of the European Society of Cardiology, in collaboration with the Association of European Paediatric Cardiologists. Eur Heart J 1998;19:19-39. DOI: https://doi.org/10.1053/euhj.1997.0787
Curigliano G, Lenihan D, Fradley M, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Annals of Oncology 2020;2:31:171-90. DOI: https://doi.org/10.1016/j.annonc.2019.10.023
Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014;15:1063-93. DOI: https://doi.org/10.1093/ehjci/jeu192
Eschenhagen T, Force T, Ewer MS, et al. Cardiovascular side effects of cancer therapies: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2011;13:1e10. DOI: https://doi.org/10.1093/eurjhf/hfq213
Onishi T, Fukuda Y, Miyazaki S, et al. Practical guidance for echocardiography for cancer therapeutics related cardiac dysfunction Journal of Echocardiography 2021;19:1-20. DOI: https://doi.org/10.1007/s12574-020-00502-9
Armenian SH, Lacchetti C, Barac A, et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017;35:893e911
Wood Peter W, Choy JB, Nanda NC, et al. Left ventricular ejection fraction and volumes: it depends on the imaging method. Echocardiography 2014;31:87-100. DOI: https://doi.org/10.1111/echo.12331
Daher IN, Kim C, Saleh RR, et al. Prevalence of abnormal echocardiographic findings in cancer patients: a retrospective evaluation of echocardiography for identifying cardiac abnormalities in cancer patients. Echocardiography 2011;28:1061-7. DOI: https://doi.org/10.1111/j.1540-8175.2011.01490.x
Frey MK, Bergler-Klein J. Echocardiographic evaluation of patients undergoing cancer therapy. European Heart Journal - Cardiovascular Imaging 2021;22:375-82. DOI: https://doi.org/10.1093/ehjci/jeaa341
Chow EJ, Chen Y, Kremer LC, et al. Individual prediction of heart failure among childhood cancer survivors. J Clin Oncol 2015;33:394-402. DOI: https://doi.org/10.1200/JCO.2014.56.1373
Ezaz G, Long JB, Gross CP, Chen J. Risk prediction model for heart failure and cardiomyopathy after adjuvant trastuzumab therapy for breast cancer. J Am Heart Assoc 2014;3:e000472. DOI: https://doi.org/10.1161/JAHA.113.000472
Tan L-L, Lyon AR. Role of biomarkers in prediction of cardiotoxicity during cancer treatment. Curr Treat Options Cardio Med 2018;20:55. DOI: https://doi.org/10.1007/s11936-018-0641-z
Cardinale D, Sandri MT, Colombo A, et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation. 2004;109: 22:2749–2754 DOI: https://doi.org/10.1161/01.CIR.0000130926.51766.CC
Horacek JM, Pudil R, Tichy M, et al. Cardiac troponin I seems to be superior to cardiac troponin T in the early detection of cardiac injury associated with anthracycline treatment. Onkologie 2008;31:559-60. DOI: https://doi.org/10.1159/000151687
Clerico A, Zaninotto M, Passino, C, et al. Evidence on clinical relevance of cardiovascular risk evaluation in the general population using cardio-specific biomarkers. Clin Chem Lab Med 2020;59:79-90. DOI: https://doi.org/10.1515/cclm-2020-0310
Curigliano G, Cardinale D, Dent S, et al. Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management. CA Cancer J Clin 2016;66:309-25. DOI: https://doi.org/10.3322/caac.21341
Chauin A. The main causes and mechanisms of increase in cardiac troponin concentrations other than acute myocardial infarction (part 1): physical exertion, inflammatory heart disease, pulmonary embolism, renal failure, sepsis. Vascular Health and Risk Management 2021;17:601-17. DOI: https://doi.org/10.2147/VHRM.S327661
Semeraro GC, Cipolla CM, Cardinale, DM. Role of cardiac biomarkers in cancer patients. Cancers 2021;13:5426. DOI: https://doi.org/10.3390/cancers13215426
Kilickap S, Barista I, Akgul E, et al. cTnT can be a useful marker for early detection of anthracycline cardiotoxicity. Ann Oncol 2005;16:798-804. DOI: https://doi.org/10.1093/annonc/mdi152
Skovgaard D, Hasbak P, Kjaer A. BNP predicts chemotherapy-related cardiotoxicity and death: comparison with gated equilibrium radionuclide ventriculography. PLoS One 2014;9:e96736. DOI: https://doi.org/10.1371/journal.pone.0096736
Sawaya H, Sebag IA, Plana JC, et al. Early detection and prediction of cardiotoxicity in chemotherapy-treated patients. Am J Cardiol 2011;107:1375e1380. DOI: https://doi.org/10.1016/j.amjcard.2011.01.006
Cardinale D, Sandri MT. Role of biomarkers in chemotherapy-induced cardiotoxicity. Prog Cardiovasc Dis 2010;53:121-9. DOI: https://doi.org/10.1016/j.pcad.2010.04.002
Cardinale D, Colombo A, Torrisi R, et al. Trastuzumab-induced cardiotoxicity: clinical and prognostic implications of troponin I evaluation. J Clin Oncol 2010;28:3910-6. DOI: https://doi.org/10.1200/JCO.2009.27.3615
Ky B, Carver JR. Biomarker approach to the detection and cardioprotective strategies during anthracycline chemotherapy. Heart Fail Clin 2011;7:323-31. DOI: https://doi.org/10.1016/j.hfc.2011.03.002
Curigliano G, Cardinale D, Suter T, et al. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Annals of Oncology 2012;23:155-66. DOI: https://doi.org/10.1093/annonc/mds293
Beresford P. Troponin fact sheet for primary care. Available from: https://www.nbt.nhs.uk/sites/default/files/Trop%20w%20%20header.pdf
Cardinale D, Biasillo G, Cipolla CM. Curing cancer, saving the heart: a challenge that cardioncology should not miss. Curr Cardiol Rep 2016;18:51. DOI: https://doi.org/10.1007/s11886-016-0731-z
Lenihan D, Oliva S, Chow E, et al. Cardiac toxicity in cancer survivors. Cancer 2013;119:2131-42. DOI: https://doi.org/10.1002/cncr.28061
DeSantis C, Lin C, Mariotto A, et al. Cancer treatment and survivorship statistics. CA Cancer J Clin 2014;64:252-7. DOI: https://doi.org/10.3322/caac.21235
Anakwue R. Cytotoxic-induced heart failure among breast cancer patients in Nigeria: a call to prevent today’s cancer patients from being tomorrow’s cardiac patients. Ann Afr Med 2020;19:1-7. DOI: https://doi.org/10.4103/aam.aam_24_19

How to Cite

Anakwue, R. C., Anakwue, A.-M., & Ekwe, E. (2024). Assessment of cardiotoxicity in cancer patients on chemotherapy in a low resource setting: is echocardiography the ultimate tool, or should we look for another?. Annals of Clinical and Biomedical Research, 5(1). https://doi.org/10.4081/acbr.2024.490