Early Detection and Prediction of Anthracycline-Induced Cardiotoxicity - A Prospective Cohort Study

Circ J. 2024 Apr 25;88(5):751-759. doi: 10.1253/circj.CJ-24-0065. Epub 2024 Mar 8.


Background: In the present study, we aimed to investigate whether early cardiac biomarker alterations and echocardiographic parameters, including left atrial (LA) strain, can predict anthracycline-induced cardiotoxicity (AIC) and thus develop a predictive risk score.Methods and Results: The AIC registry is a prospective, observational cohort study designed to gather serial echocardiographic and biomarker data before and after anthracycline chemotherapy. Cardiotoxicity was defined as a reduction in left ventricular ejection fraction (LVEF) ≥10 percentage points from baseline and <55%. In total, 383 patients (93% women; median age, 57 [46-66] years) completed the 2-year follow-up; 42 (11.0%) patients developed cardiotoxicity (median time to onset, 292 [175-440] days). Increases in cardiac troponin T (TnT) and B-type natriuretic peptide (BNP) and relative reductions in the left ventricular global longitudinal strain (LV GLS) and LA reservoir strain [LASr] at 3 months after anthracycline administration were independently associated with subsequent cardiotoxicity. A risk score containing 2 clinical variables (smoking and prior cardiovascular disease), 2 cardiac biomarkers at 3 months (TnT ≥0.019 ng/mL and BNP ≥31.1 pg/mL), 2 echocardiographic variables at 3 months (relative declines in LV GLS [≥6.5%], and LASr [≥7.5%]) was generated.

Conclusions: Early decline in LASr was independently associated with subsequent cardiotoxicity. The AIC risk score may provide useful prognostication in patients receiving anthracyclines.

Keywords: Anthracyclines; Cancer therapy-related cardiac dysfunction; Cardio-oncology; Left atrial strain; Risk score.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Anthracyclines* / adverse effects
  • Biomarkers / blood
  • Cardiotoxicity*
  • Early Diagnosis
  • Echocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain* / blood
  • Prospective Studies
  • Registries
  • Troponin T / blood


  • Anthracyclines
  • Natriuretic Peptide, Brain
  • Biomarkers
  • Troponin T