Heart of the Matter

Risk of cardiomyopathy is heightened for childhood cancer survivors, but its often asymptomatic nature makes early detection less than straightforward. Now, a team from St. Jude Children’s Research Hospital have found two biomarkers – global longitudinal strain (GLS) and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) – capable of predicting cardiomyopathy that would otherwise go undetected by conventional screenings (1, 2).

Echocardiograms are the gold standard for assessment of heart function. However, many cancer survivors with a seemingly normal ejection fraction can be later diagnosed with cardiomyopathy. “A survivor with a normal ejection fraction at baseline with abnormal ranges of both biomarkers was at a fourfold increased risk for a worsening ejection fraction in the next five years,” said lead author Matthew Ehrhardt, in a press release. GLS is an additional measure obtained from an echocardiogram, with the researchers suggesting that it is more sensitive for detecting cardiac muscle injury than normal ejection fraction. Meanwhile, NT-proBNP, which can be obtained from a simple blood test, appears in greater quantities when the heart is overworked.

“One of the promising aspects of our findings is that both of these measures are readily available and, therefore, have the potential to impact care more immediately,” said Ehrhardt. The researchers hope that these biomarkers will limit unnecessary tests for childhood cancer patients. “We were somewhat surprised by the magnitude of risk for declining heart function over such a relatively short period in individuals with abnormal GLS and NT-proBNP,” he concluded. The study’s findings could help provide early and effective interventions that prevent progression to heart failure over time.