The Joint Role of Serum Markers of Congestion or Myocardial Necrosis And Speckle Tracking Echocardiography in The Detection of Early Subtle Chemotherapy-Induced Cardiotoxicity in Women With Breast Cancer.

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2025-07-07 DOI:10.18087/cardio.2025.6.n2933

N Raiimbek Uulu, I V Pershukov, L V Shulzhenko, B A Akbalaeva, T A Batyraliev, O V Gurovich, R K Kalmatov, S M Mamatova, N T Jainakbayev, A O Seidalin, A T Mansharipova, M V Kvasova, V V Vinogradskaia, Z A Karben, D V Fettser, J M O Ramazanov, T N Kuznetsova, E Yu Ivanenkova, R N Rakhalskaya, M R Kamaliyeva

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Abstract

Aim To monitor the dynamics of biomarkers during chemotherapy, targeted chemotherapy and targeted monotherapy in patients with HER2-positive breast cancer (BC); to analyze the emergence timing of these changes; to compare early biochemical and echocardiographic criteria; and to determine the best time for assessing latent subclinical cardiac dysfunction.Material and methods Patients with BC (229 women aged 57±11 years) treated sequentially with anthracyclines, a combination of docetaxel and trastuzumab, and trastuzumab monotherapy were examined during three blocks of BC therapy until the development of clinical cardiotoxicity. Time-related changes in high-sensitivity cardiac troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular (LV) global longitudinal strain (GLS) and LV ejection fraction (EF) (up to 12 speckle-tracking echocardiograms/up to 12 laboratory tests) were analyzed. Clinical cardiotoxicity was defined as a symptomatic decrease in LV EF ≥10% from the baseline value of 54% or more.Results Clinically significant cardiotoxicity developed in 6.3-10.9% of cases depending on the treatment option for BC. Early manifestations of cardiotoxicity were detected already at 3 weeks after the start of the first course of chemotherapy. For the BC treatment with anthracyclines and targeted chemotherapy with docetaxel and trastuzumab, the markers of clinical cardiotoxicity were high-sensitivity cardiac troponin I, NT-proBNP and GLS LV. For the trastuzumab monotherapy, only GLS LV had a prognostic value. No statistically significant changes in the concentrations of high-sensitivity troponin I and NT-proBNP were found.Conclusion For timely detection of clinical cardiotoxicity, laboratory tests (high-sensitivity troponin I, NT-proBNP) and echocardiography (GLS LV) are recommended to be performed every 3 weeks before the next course of BC therapy. While doing so, their sensitivity will depend on the treatment option for BC.

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血清充血或心肌坏死标志物与斑点跟踪超声心动图联合检测乳腺癌妇女早期细微化疗引起的心脏毒性的作用

目的监测her2阳性乳腺癌（BC）患者化疗、靶向化疗和靶向单药治疗期间生物标志物的动态变化；分析这些变化的出现时机；比较早期生化指标与超声心动图指标；并确定评估潜在亚临床心功能障碍的最佳时间。材料和方法229例女性（年龄57±11岁）依次接受蒽环类药物、多西他赛和曲妥珠单抗联合治疗和曲妥珠单抗单药治疗，在3个疗程的BC治疗中进行检查，直到出现临床心脏毒性。分析了高灵敏度心肌肌钙蛋白I、n端脑利钠肽前体（NT-proBNP）、左室（LV）整体纵向应变（GLS）和左室射血分数（EF）的时间相关变化（多达12个斑点跟踪超声心动图/多达12个实验室检查）。临床心脏毒性定义为左室EF较基线值54%或更高的症状性下降≥10%。结果根据BC的治疗方案不同，6.3-10.9%的病例出现临床显著的心脏毒性。在第一疗程化疗开始后3周就已发现心脏毒性的早期表现。对于蒽环类药物治疗BC以及多西紫杉醇和曲妥珠单抗靶向化疗，临床心脏毒性标志物为高敏感性心肌肌钙蛋白I、NT-proBNP和GLS LV。对于曲妥珠单抗单药治疗，只有GLS LV具有预后价值。高敏感性肌钙蛋白I和NT-proBNP浓度变化无统计学意义。结论为了及时发现临床心脏毒性，建议在下一个疗程前每3周进行一次实验室检查（高灵敏度肌钙蛋白I， NT-proBNP）和超声心动图（GLS LV）。虽然这样做，他们的敏感性将取决于治疗方案的BC。

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.