Troponin I, cardiac ventricular dysfunction and causal toxicity of chemotherapy drugs
| Autor: | Laetitia Delval |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Chemotherapy
medicine.medical_specialty Acute coronary syndrome Lung Septic shock business.industry medicine.medical_treatment Dilated cardiomyopathy Hematology musculoskeletal system medicine.disease Asymptomatic Surgery Systemic inflammatory response syndrome Sepsis medicine.anatomical_structure Oncology Internal medicine cardiovascular system medicine Cardiology medicine.symptom business |
| Zdroj: | Annals of Oncology. 13:1952 |
| ISSN: | 0923-7534 |
| DOI: | 10.1093/annonc/mdf345 |
| Popis: | I read with great interest the report by Cardinale et al. [1] that elevation of cardiac troponin I (TnI) after treatment with high-dose chemotherapy in breast cancer patients is an early marker of asymptomatic myocardial injury and predicts chemotherapy-induced late ventricular impairment. In their series of 211 consecutive patients, 70 (33%) presented a slight elevation of TnI [mean (± SD) 0.9 ± 0.5 ng/ml] during the treatment period. The increase in TnI occured a few hours after chemotherapy infusion, and a significant reduction in left ventricular (LV) function was observed in the group of patients with positive TnI, compared with the group with no elevation of TnI. However, I am concerned that the authors do not mention the presence (or lack) of other medical conditions or complications of the chemotherapeutic treatment that could, by themselves, be responsible for a secondary cardiac dysfunction. A clear relationship between elevated TnI and LV dysfunction has been previously established in septic patients [2] and in hypovolemic-hypotensive patients [3]. Studies on the clinical conditions associated with elevation of TnI have shown that TnI was elevated (slight to moderate elevation) in 85% of patients with systemic inflammatory response syndrome, sepsis and septic shock [4]. Kahn et al. reported that 35/102 consecutive patients with slight elevation of TnI [mean (± SD) 2.0 ± 1.9 ng/ml] did not have the final diagnosis of acute coronary syndrome, but had various other medical problems including non-ischemic dilated cardiomyopathy, muscular disorders, central nervous system disorders, HIV disease, chronic renal failure, sepsis, lung diseases and endocrine disorders [5]. Thus, elevated TnI, especially slight elevation, should be interpreted with caution. TnI is likely to be a sensitive early marker of LV dysfunction, but is not a specific marker for the origin of the cardiac dysfunction. Therefore, in the absence of further information about the presence of other medical problems, it cannot be assumed that the LV dysfunction is solely attributable to a cardiotoxic effect of the chemotherapeutic treatment. Oncologists facing an elevation of TnI should consider the possible causes of the enzyme elevation in their decision making process to modify or discontinue an antineoplastic treatment. Particularly, a sepsis or a hypovolemic-hypotensive problem has to be excluded. |
| Databáze: | OpenAIRE |
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