The value of troponin measurement in assessment of anthracycline induced-cardio toxicity in breast cancer patients

Abstract EN

Purpose : Anthracyclines are the most frequent cause of treatment induced cardio toxicity affecting about 7-15 % of patients receiving more than 450-500 mg / m2, cumulative dose [16].

The aim of the present study is to determine the efficacy of a new biochemical marker, cardiac troponin (cTnI), in the diagnosis of acute cardiac myocyte injury by anthracycline containing chemotherapy and to compare its value versus the standard echo parameters.

Material and Methods : the study included 31 pre-menopausal breast cancer patients presented to NEM-ROCK during the period September 98 to June 99.

Only 26 patients completed the full course of chemo radio-therapy protocol (6 cycles of FAC and concomitant radical RT) with serial serum monitoring of Troponin-1 performed 24 hrs after each cycle.

In addition to serial serum CK-MB and echocardiogram on cycles 2, 4 and 6.

Results : Analysis of variance with repeated measures revealed high statistical significance between the baseline serum troponin I and subsequent measures after each cycle.

Serial values of CK-MB concentrations revealed no statistical significant change from the base line measurement.

Also, there was statistical significance between the baseline fractional shortening and those values after the second, fourth and sixth cycle of treatment.

Multivariate analysis of various risk factors related to cardio toxicity revealed statistically significant difference between the mean dose of irradiation delivered to the heart volume and serum troponin I after the 2nd cycle (p = 0.02) and this may be explained by the combined effect of chemo-radiation.

Also, there was a high statistically significant relationship between the Adriamycin dose and the serum troponin I level after the 5th cycle of chemotherapy due to the cumulative effect of anthracyclines (p = 0.0004).

Conclusion : the use of serial serum monitoring of cardiac troponin I as an early sensitive detector of acute myo-cyte injury could be of value following anthracycline base chemotherapy.