|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 170-171
Assessment of anthracycline-induced long-term cardiotoxicity in patients with hematological malignancies
Nephrology and Renal Transplantation Centre, The Medical City, Baghdad, Iraq
|Date of Submission||05-Mar-2020|
|Date of Acceptance||26-Jun-2020|
|Date of Web Publication||10-Nov-2020|
Dr. Ala Ali
Nephrology and Renal Transplantation Centre, The Medical City, Baghdad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ali A. Assessment of anthracycline-induced long-term cardiotoxicity in patients with hematological malignancies. Iraqi J Hematol 2020;9:170-1
We read with great interest the paper “Assessment of anthracycline-induced long-term cardiotoxicity in patients with hematological malignancies.” We would like to share some points with the authors.
There was an Iraqi study about the prediction of anthracycline-induced cardiotoxicity earlier than this study.
The outcomes were different (prediction vs. identification). The projected incidence in the first study was 38.7%. The case definition was different between the two studies. Al-Rubaye et al. used echocardiography (ECHO) and electrocardiography (ECG) while the Ali AA et al. incorporated cardiac troponin to Echo and ECG for case definition of Anthracycline induced cardiotoxicity.
The study by Ali AA et al. recruited patients with no prior comorbidities, while (20% of Al-Rubaye et al.'s study had hypertension, diabetes, renal disease, and hypothyroidism). These comorbidities may contribute to the risk of cardiac dysfunction after receiving chemotherapy. On the other hand, this may be a better representative sample describing the complexity of managing such patient. In addition, eight patients (16%) received radiotherapy but no one in first study.
Acute myeloid leukemia was the most common hematological diagnosis in both studies.
The cumulative doxorubicin dose was in the same range in both studies. It was 282.6 mg/m 2 vs. 204.7 mg/m 2 in the other study and ranging between 100 and 450 mg/m 2.
The last issue is that the first study used troponin as an indicator of cardiac injury. The constellation of ECG, ECHO, and troponin increased the sensitivity of predicting anthracycline-induced cardiotoxicity by 95%. The troponin test is simple, cheap, and easily applicable. The utility of troponin had been tested in other studies and in different chemotherapy protocols for hematologic or solid malignancies.
The use of composite model of biomarkers and imaging may be more useful than each alone for early detection.
Predictive model may be useful to look for a possible early cardiac dysfunction. Frequently, by the time cardiotoxicity is detected, significant left ventricular dysfunction has occurred, and ultimately, this may not respond to standard cardioprotective treatment.
Thanks for the great efforts by all authors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ali AA, Al-Mudhafar AM. Prediction of anthracycline induced cardiotoxicity: Study of thirty-one Iraqi adult patients. Gulf J Oncolog 2011;1:33-9.
Simões R, Silva LM, Cruz AL, Fraga VG, de Paula Sabino A, Gomes KB. Troponin as a cardiotoxicity marker in breast cancer patients receiving anthracycline-based chemotherapy: A narrative review. Biomed Pharmacother 2018;107:989-96.
Quatromoni N, Scherrer-Crosbie M. Update on incorporating biomarkers with imaging findings for the detection and management of cardiotoxicity. Curr Cardiol Rep 2018;20:67.
Stevens PL, Lenihan DJ. Cardiotoxicity due to chemotherapy: The role of biomarkers. Curr Cardiol Rep 2015;17:603.