A Biomarker-Based Diagnostic Model for Cardiac Dysfunction in Childhood Cancer Survivors

Childhood cancer survivors at risk for heart failure undergo lifelong echocardiographic surveillance. Previous studies reported the limited diagnostic accuracy of N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) in detecting left ventricular (LV...

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Published in:JACC CardioOncology 2024-04, Vol.6 (2), p.236-247
Main Authors: Leerink, Jan M., Feijen, Elizabeth A.M., de Baat, Esmee C., Merkx, Remy, van der Pal, Helena J.H., Tissing, Wim J.E., Louwerens, Marloes, van den Heuvel-Eibrink, Marry M., Versluys, A. Birgitta, van Dalen, Elvira C., van der Heiden-van der Loo, Margriet, Bresters, Dorine, Ronckers, Cécile M., de Vries, Andrica C.H., Neggers, Sebastian, Kapusta, Livia, Loonen, Jacqueline, Pinto, Yigal M., Kremer, Leontien C.M., Mavinkurve-Groothuis, Annelies M.C., Kok, Wouter E.M.
Format: Article
Language:English
Subjects:
biomarkers
cardio-oncology
childhood cancer survivors
diagnostic accuracy
Mini-Focus Issue: Anthracyclines
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Summary:Childhood cancer survivors at risk for heart failure undergo lifelong echocardiographic surveillance. Previous studies reported the limited diagnostic accuracy of N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) in detecting left ventricular (LV) dysfunction. However, potential enhanced diagnostic accuracy through the combination of biomarkers and clinical characteristics has been suggested. The aim of this study was to develop and internally validate a diagnostic model that combines cardiac biomarkers with clinical characteristics for effectively ruling in or ruling out LV dysfunction in childhood cancer survivors. A multicenter cross-sectional study included 1,334 survivors (median age 34.2 years) and 278 siblings (median age 36.8 years). Logistic regression models were developed and validated through bootstrapping, combining biomarkers with clinical characteristics. Abnormal NT-proBNP levels were observed in 22.1% of survivors compared with 5.4% of siblings, whereas hs-cTnT levels exceeding 10 ng/L were uncommon in both survivors (5.9%) and siblings (5.0%). The diagnostic models demonstrated improvement upon the addition of NT-proBNP and hs-cTnT to clinical characteristics, resulting in an increased C statistic from 0.69 to 0.73 for LV ejection fraction (LVEF) 
ISSN:2666-0873
2666-0873
DOI:10.1016/j.jaccao.2024.02.008