Evaluation Of Chemothreapy-induced Subclinical Heart Function Damage Using Cardiac Troponin Level And Speckle Tracking Imaging

ObjectiveChemotherapy plays indispensible role in cancer treatment. However, cardiotoxicity is arecognised chemotherapy-induced adverse event which cannot be neglected in clinicalpractice. The testing of serum cardiac troponin, a specific indicator for cardiac muscledamage, is a common method in clinical practice and offer several advantages such aseasy operation, high sensitivity and good reproducibility. Two-dimensional speckletracking imaging technology (2D-STI) is a new imaging technique which enablesevaluation of cardiac systolic and diastolic function by qualitatively and quantitativelymeasuring peak systolic velocity, strain, strain rates, and the heart of the rotation anglesand rotation speed for monitoring heart injury. The objective of this study was tomonitor the heart function of the cancer patients during chemotherapy treatment bymeasuring serum troponin level and2D-STI in order to evaluate the cardiotoxicity ofthe chemotherapeutic drugs. MethodsA total of108patients with pathological diagnosed malignant tumor were recruited inthe study. Every patient were studied in four stages (before chemotherapy, after the firstcycle of chemotherapy, middle cycle of chemothrapy and after the last cycle ofchemotherapy). In each stage, serum cardiac troponin T (cTnT), troponin I (cTnI)testing and Electrocardiography (ECG) were applied. The global longitudinal systolicstrain(GLS) and strain rate (GLSRs) of LV as well as early-diastolic strain rate(GLSRe)and late-diastolic strain rate (GLSRa) were measured by2D-STI in apicallong-axis,four-chamber and two chamber views.Results1.No serious cardiac events (sudden cardiac death, ventricular arrhythmia, cardiogenichypotension) occurred during chemotherapy. Patients complained of palpitations in1case (0.92%), chest tightness in1case (0.92%). Abnormal ECG diagnosed rate weresignificantly different (P <0.05) among three stages (after the first cycle ofchemotherapy, middle cycle of chemothrapy and after the last cycle of chemotherapy).2.Serum level of cTnT, cTnI in turn gradually increased during every stages ofchemotherapy, were statistically significant (P <0.01) compared with the data beforetreatment. 3.GLS, GLSRs, GLSRe, GLSRa shown no significant change (P>0.05) after initialchemotherapy; Decreased GSRe, GSRa were statistically significant (P <0.01) whereasGSL, GSRS decreased but didn’t show statistically significant (P>0.05) in half of thefull treatment; GLS, GLSRS, GLSRe and GLSRa are all decreased, and the differencewas statistically significant (P<0.01) after the last cycle of chemotherapy.4. The troponin levels of three chemotherapeutic regimens gradually increased with thechemotherapy process. However, patients using TAC shown the largest increase,followed by the regimen of paclitaxel combined with cisplatin and FOLFOX4.ConclusionChemotherapy drugs can induce subclinical damage of heart, aggravated with thecumulative dose. The TAC regimen demonstrated severer cardiotoxicity comparing toother two regimens. However, FOLFOX4regimen has also revealed certaincardiatoxicity. Monitoring of serum troponin levels as well as2D-STI techniques enableearly detection of the cardiac function influenced by chemotherapy, therefore providinga more sensitive and practical monitoring methods in clinical practice.