Numerous biomarkers have also been evaluated for
use in the risk prediction of cardiotoxicity. B-type
natriuretic peptide (BNP) and troponin I are two of
the common markers that have been investigated.
In cancer patients who received cardiotoxic chemotherapy,
an elevated BNP of greater than 100 pg/ml
carried a hazard ratio of 5.5 [95% confidence interval
(CI) 1.8–17.2] for heart failure. BNP was also
predictive of mortality (hazard ratio 1.9, 95% CI
1.3–2.9) [10]. Elevations of troponin I soon after
and 1 month after high-dose cardiotoxic chemotherapy
were predictive of long-term risk for cardiac
events. Patients with an elevated troponin I at both
time points had an 84% risk of cardiac events in the
3-year follow-up compared with a1% risk in patients
with negative troponin I at both time points [11].
Other studies have verified that elevated troponin I
and ultrasensitive troponin I after therapy may be
indicative of impending cardiotoxicity [12&&,13].
Although biomarkers are not routinely monitored,
a number of studies have explored the incremental
value of biomarkers to clinical factors and imaging
findings to more accurately define risk prediction