Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy

OBJECTIVES We investigated the role of cardiac troponin I (cTnI) in patient s with aggressive malignancies treated with high-dose chemotherapy (HDC). BACKGROUND High dose chemotherapy is potentially limited by cardiac toxicit y. Considering the fact that cardiac dysfunction may become clinically evid ent weeks or months after HDC, the availability of an early marker of myoca rdial injury, able to predict late ventricular impairment, is a current nee d. METHODS We measured, in 204 patients (45 +/- 10 years) affected by cancer r esistant to conventional treatment, the cTnI plasma concentration after eve ry single cycle of HDC. According to the cTnI value (less than or equal to or >0.4 ng/ml), patients were divided into a troponin positive (cTnI+, n = 65) and a troponin negative (cTnT-, n = 139) group. All patients underwent echocardiographic examination during the following seven months. RESULTS In the cTnI- group, left Ventricular ejection fraction (LVEF) progr essively decreased after HDC, reaching a maximal reduction after three mont hs; however, myocardial depression was transient and no longer detectable a t later follow-up. By contrast, in the cTnI+ group LVEF reduction was more marked and still evident at the end of the follow-up. In cTnI+ patients, a close relationship between the short-term cTnI increment and the greatest L VEF reduction was found (r = -0.87, p < 0.0001). CONCLUSIONS The elevation of cTnI in patients undergoing HDC for aggressive malignancies accurately predicts the development of future LVEF depression . In this setting, cTnI can be considered a sensitive and reliable marker o f acute minor myocardial damage with relevant clinical and prognostic impli cations. (C) 2000 by the American College of Cardiology.