Detection and monitoring of cardiotoxicity by using biomarkers: Pros and cons: Remarks on the international colloquium on cardioncology.

Long-term survival of cancer patients can be worsened by cardiovascular morbidity and mortality due to anticancer treatments, based on both traditional and novel anticancer drug-based regimens. The current standard for monitoring cardiac function, based on periodic assessment of left ventricular ejection fraction by transthoracic echocardiography or multi-gated radionuclide angiography, detects cardiotoxicity only when a functional impairment has already occurred, precluding any chance of preventing its development. The limitations of this approach may be surmounted by the use of cardiac biomarkers. Many studies performed both in children and in adults have shown that slight increases in troponins are predictors of further development of cardiac dysfunction. However, other studies failed to find any usefulness in troponin determination. These discrepancies may be due to different times of sampling, lack of standardization, the use of different methods with different sensitivity, and finally not uniformly defined cardiac endpoints. Beyond troponins, the most studied biomarkers in cancer patients treated with potentially cardiotoxic drugs are natriuretic peptides. For them no definite conclusions can be drawn; however, as the findings available in literature show different results. Still, most of data indicate that the persistent increase of BNP or NT-proBNP is associated with the evidence of cardiac dysfunction. Troponin is the gold standard marker for evaluating chemotherapy-induced cardiac injury; BNP and NT-proBNP are hemodynamic indexes. Hence, if we are looking for early myocardial damage during chemotherapy the most useful marker may be troponin; conversely, if we are looking for cardiac dysfunction in asymptomatic long-term cancer survivors, BNP and NT-proBNP are probably the biomarkers of choice.