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Efficacy of Novel Cardiac Biomarkers in Detecting Anthracycline- Induced Cardiac Toxicity


avatar Saeedreza Shirzadi ORCID 1 , avatar Roham Borazjani ORCID 1 , avatar Armin Attar ORCID 2 , *

1 Students’ Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

How to Cite: Shirzadi S , Borazjani R , Attar A. Efficacy of Novel Cardiac Biomarkers in Detecting Anthracycline- Induced Cardiac Toxicity. Int Cardio Res J. 2021;15(2):e116347.


International Cardiovascular Research Journal: 15 (2); e116347
Published Online: June 30, 2021
Article Type: Research Article
Received: May 17, 2021
Revised: June 14, 2021
Accepted: July 06, 2021


Background: Anthracyclines can induce injuries to cardiac myocytes. Performance of echocardiography to detect Anthracycline Induced Cardiotoxicity (ACIC) for all patients under chemotherapeutic regimens is neither feasible nor cost-effective.
Objectives: This study aimed to investigate the changes in the serum levels of cardiac novel biomarkers after anthracycline usage to determine whether they are suitable candidates for screening or diagnosing ACIC.
Methods: In this pre-post study, patients without previous cardiovascular diseases who were candidates for chemotherapy with anthracyclines were recruited. The study was conducted on 30 patients selected through simple random sampling. Echocardiography and measurement of the serum levels of NT-pro Brain Natriuretic Peptide (BNP), soluble ST2, Galectin 3, and Growth Differentiation Factor-15 (GDF-15) were performed before
chemotherapy and six months after the last session. ACIC was defined based on the echocardiographic criteria. Paired sample t-test was used to compare the biomarker levels. In addition, Receiver Operating Characteristic (ROC) curve was used to assess the specificity and sensitivity of the significant biomarkers in predicting the changes in Left Ventricular Ejection Fraction (LVEF).
Results: This study was conducted on 30 patients, 16 ones of whom had developed ACIC. The results revealed a significant increase in the serum levels of soluble ST2 (134.71 ± 60.46 vs. 137.49 ± 61.38, P = 0.011) and galectin 3 (6.82 ± 3.18 vs. 7.19 ± 3.29 ng/mL, P < 0.001) among the patients who had developed ACIC. ROC curve analysis showed that a soluble ST2 level ≥ 46.63 ng/ml could predict the occurrence of ACIC with 62.5% sensitivity and 100% specificity (AUC = 0.835, P < 0.001, NPV = 70%, PPV = 100%).
Conclusions: This was the first study, which simultaneously evaluated multiple biomarkers for the detection of ACIC. Among these biomarkers, only soluble ST2 demonstrated a promising ability for the detection of ACIC.


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