Startseite Cardiotoxic effects and myocardial injury: the search for a more precise definition of drug cardiotoxicity
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Cardiotoxic effects and myocardial injury: the search for a more precise definition of drug cardiotoxicity

  • Daniela Maria Cardinale , Martina Zaninotto , Carlo Maria Cipolla , Claudio Passino , Mario Plebani ORCID logo und Aldo Clerico EMAIL logo
Veröffentlicht/Copyright: 26. August 2020
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 59 Heft 1

Abstract

Drug-induced cardiotoxicity is a major clinical problem; cardiotoxic drugs may induce both cardiac dysfunction and myocardial injury. Several recent studies reported that cardiac troponins measured with high-sensitivity methods (hs-cTn) can enable the early detection of myocardial injury related to chemotherapy or abuse of drugs that are potentially cardiotoxic. Several authors have some concerns about the standard definition of cardiotoxicity, in particular, regarding the early evaluation of chemotherapy cardiotoxicity in cancer patients. Several recent studies using the hs-cTn assay indicate that myocardial injury may precede by some months or years the diagnosis of heart failure (HF) based on the evaluation of left ventricular ejection fraction (LVEF). Accordingly, hs-cTn assay should considered to be a reliable laboratory test for the early detection of asymptomatic or subclinical cardiotoxic damage in patients undergoing cancer chemotherapy. In accordance with the Fourth Universal Definition of Myocardial Infarction and also taking into account the recent experimental and clinical evidences, the definition of drug-cardiotoxicity should be updated considering the early evaluation of myocardial injury by means of hs-cTn assay. It is conceivable that the combined use of hs-cTn assay and cardiac imaging techniques for the evaluation of cardiotoxicity will significantly increase both diagnostic sensitivity and specificity, and also better prevent chemotherapy-related left ventricular (LV) dysfunction and other adverse cardiac events. However, large randomized clinical trials are needed to evaluate the cost/benefit ratio of standardized protocols for the early detection of cardiotoxicity using hs-cTn assay in patients receiving chemotherapy for malignant diseases.

Keywords: cardiac troponins; cardiotoxicity; chemotherapy; high-sensitivity methods; myocardial injury
Corresponding author: Professor Aldo Clerico, MD, Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine, Fondazione CNR Toscana G. Monasterio, Scuola Superiore Sant’Anna, Via Trieste 41, Pisa, 56126, Italy, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

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Received: 2020-04-23
Accepted: 2020-08-06
Published Online: 2020-08-26
Published in Print: 2021-01-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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  46. Performance of perpendicular drop versus tangent skimming gating of M-protein in proficiency testing challenges
  47. Analytical evaluation of Reebio procalcitonin latex-enhanced immunoturbidimetric assay on the HITACHI Labospect 008AS
  48. Assessment of intraindividual agreement in prolactin results after post-polyethylene glycol precipitation test for the estimation of macroprolactin. Should the precipitation procedure be repeated in the same patient?
  49. Aggregation kinetic and temperature optimum of an EDTA-dependent pseudothrombocytopenia
https://doi.org/10.1515/cclm-2020-0566
Schlagwörter für diesen Artikel
cardiac troponins; cardiotoxicity; chemotherapy; high-sensitivity methods; myocardial injury

Artikel in diesem Heft

  1. 10.1515/cclm-2020-frontmatter1
  2. Mario Plebani turns 70
  3. Editorial
  4. Measurement uncertainty and the importance of correlation
  5. Reviews
  6. Untangling the association between prostate-specific antigen and diabetes: a systematic review and meta-analysis
  7. The emerging role of cell senescence in atherosclerosis
  8. Mini Review
  9. Minimum retesting intervals in practice: 10 years experience
  10. Opinion Paper
  11. Cardiotoxic effects and myocardial injury: the search for a more precise definition of drug cardiotoxicity
  12. EFLM Papers
  13. The CRESS checklist for reporting stability studies: on behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE)
  14. Thoughts and expectations of young professionals about the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)
  15. Guidelines and Recommendations
  16. Evidence on clinical relevance of cardiovascular risk evaluation in the general population using cardio-specific biomarkers
  17. Genetics and Molecular Diagnostics
  18. A systematic evaluation of stool DNA preparation protocols for colorectal cancer screening via analysis of DNA methylation biomarkers
  19. General Clinical Chemistry and Laboratory Medicine
  20. The new IVD Regulation 2017/746: a case study at a large university hospital laboratory in Belgium demonstrates the need for clarification on the degrees of freedom laboratories have to use lab-developed tests to improve patient care
  21. Evaluation of serum electrolytes measurement through the 6-year trueness verification program in China
  22. Feasibility for aggregation of commutable external quality assessment results to evaluate metrological traceability and agreement among results
  23. Sample size and rejection limits for detecting reagent lot variability: analysis of the applicability of the Clinical and Laboratory Standards Institute (CLSI) EP26-A protocol to real-world clinical chemistry data
  24. Effects of calcium dobesilate (CaD) interference on serum creatinine measurements: a national External Quality Assessment (EQA)-based educational survey of drug-laboratory test interactions
  25. Mass spectrometric sample identification with indicator compounds introduced via labeled sample tubes
  26. Automation and validation of a MALDI-TOF MS (Mass-Fix) replacement of immunofixation electrophoresis in the clinical lab
  27. A new strategy implementing mass spectrometry in the diagnosis of congenital disorders of N-glycosylation (CDG)
  28. Analytical evaluation of four faecal immunochemistry tests for haemoglobin
  29. Reference Values and Biological Variations
  30. Study of total error specifications of lymphocyte subsets enumeration using China National EQAS data and Biological Variation Data Critical Appraisal Checklist (BIVAC)-compliant publications
  31. Mass spectrometric quantification of urinary 6-sulfatoxymelatonin: age-dependent excretion and biological variation
  32. Establishment of international autoantibody reference standards for the detection of autoantibodies directed against PML bodies, GW bodies, and NuMA protein
  33. Hematology and Coagulation
  34. Appropriate thresholds for accurate screening for β-thalassemias in the newborn period: results from a French center for newborn screening
  35. Cardiovascular Diseases
  36. Analysis of B-type natriuretic peptide impurities using label-free data-independent acquisition mass spectrometry technology
  37. Diabetes
  38. Hemoglobin variants in southern China: results obtained during the measurement of glycated hemoglobin in a large population
  39. Potential of MALDI-TOF mass spectrometry to overcome the interference of hemoglobin variants on HbA1c measurement
  40. Acknowledgment
  41. Acknowledgment
  42. Letter to the Editors
  43. Measurement uncertainty estimation for derived biological quantities
  44. Non-reproducible cardiac troponin results occurring with a particular reagent lot
  45. Successfully meeting analytical expectations for the fast 0/1-h algorithm for NSTEMI by internal control procedures for cardiac troponin T
  46. Performance of perpendicular drop versus tangent skimming gating of M-protein in proficiency testing challenges
  47. Analytical evaluation of Reebio procalcitonin latex-enhanced immunoturbidimetric assay on the HITACHI Labospect 008AS
  48. Assessment of intraindividual agreement in prolactin results after post-polyethylene glycol precipitation test for the estimation of macroprolactin. Should the precipitation procedure be repeated in the same patient?
  49. Aggregation kinetic and temperature optimum of an EDTA-dependent pseudothrombocytopenia
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