{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:55:29Z","timestamp":1792684529776,"version":"4.5.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,1,21]]},"abstract":"\n Background<\/jats:title>\n \n We examined the longitudinal associations between changes in cardiovascular biomarkers and cancer therapy\u2013related cardiac dysfunction (\n CTRCD<\/jats:styled-content>\n ) in patients with breast cancer treated with cardotoxic cancer therapy.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Repeated measures of high\u2010sensitivity cardiac troponin T (hs\u2010\n cTnT<\/jats:styled-content>\n ),\n NT<\/jats:styled-content>\n \u2010pro\n BNP<\/jats:styled-content>\n (N\u2010terminal pro\u2010B\u2010type natriuretic peptide), myeloperoxidase, placental growth factor, and growth differentiation factor 15 were assessed longitudinally in a prospective cohort of 323 patients treated with anthracyclines and\/or trastuzumab followed over a maximum of 3.7\u00a0years with serial echocardiograms.\n CTRCD<\/jats:styled-content>\n was defined as a \u226510% decline in left ventricular ejection fraction to a value <50%. Associations between changes in biomarkers and left ventricular ejection fraction were evaluated in repeated\u2010measures linear regression models. Cox regression models assessed the associations between biomarkers and\n CTRCD<\/jats:styled-content>\n . Early increases in all biomarkers occurred with anthracycline\u2010based regimens. hs\u2010\n cTnT<\/jats:styled-content>\n levels >14\u00a0ng\/L at anthracycline completion were associated with a 2\u2010fold increased\n CTRCD<\/jats:styled-content>\n risk (hazard ratio, 2.01; 95%\n CI<\/jats:styled-content>\n , 1.00\u20134.06). There was a modest association between changes in\n NT<\/jats:styled-content>\n \u2010pro\n BNP<\/jats:styled-content>\n and left ventricular ejection fraction in the overall cohort; this was most pronounced with sequential anthracycline and trastuzumab (1.1% left ventricular ejection fraction decline [95%\n CI<\/jats:styled-content>\n , \u22121.8 to \u20130.4] with each\n NT<\/jats:styled-content>\n \u2010pro\n BNP<\/jats:styled-content>\n doubling). Increases in\n NT<\/jats:styled-content>\n \u2010pro\n BNP<\/jats:styled-content>\n were also associated with\n CTRCD<\/jats:styled-content>\n (hazard ratio per doubling, 1.56; 95%\n CI<\/jats:styled-content>\n , 1.32\u20131.84). Increases in myeloperoxidase were associated with\n CTRCD<\/jats:styled-content>\n in patients who received sequential anthracycline and trastuzumab (hazard ratio per doubling, 1.28; 95%\n CI<\/jats:styled-content>\n , 1.04\u20131.58).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Cardiovascular biomarkers may play an important role in\n CTRCD<\/jats:styled-content>\n risk prediction in patients with breast cancer who receive cardiotoxic cancer therapy, particularly in those treated with sequential anthracycline and trastuzumab therapy.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 01173341.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.014708","type":"journal-article","created":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T05:04:25Z","timestamp":1579583065000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":152,"title":["Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction"],"prefix":"10.1161","volume":"9","author":[{"given":"Biniyam G.","family":"Demissei","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Hubbard","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology & Informatics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karyn","family":"Sheline","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Narayan","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Domchek","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"DeMichele","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payal","family":"Shah","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy S.","family":"Clark","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Fox","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Matro","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela R.","family":"Bradbury","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Knollman","sequence":"additional","affiliation":[{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly D.","family":"Getz","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saro H.","family":"Armenian","sequence":"additional","affiliation":[{"name":"Department of Population Sciences City of Hope Duarte CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Januzzi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. H. Wilson","family":"Tang","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Ky","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Department of Biostatistics, Epidemiology & Informatics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"},{"name":"Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.3841"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.635144"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw022"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.70.5400"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw211"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002843"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307894"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2011.03.002"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-017-0602-9"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)00748-8"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000130926.51766.CC"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.27.3615"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.01.006"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.112.973321"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-10-1359"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.061"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2015.241232"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.65.7916"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10928-018-9579-8"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2011.439"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0096736"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.05.019"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.11.024"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052306"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1541-0420.2005.00323.x"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/biom.12562"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2005.04.022"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.01.021"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004675"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.114.002217"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.68.7830"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.006513"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2018.02.005"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.049"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.020"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.114.001427"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.11.005"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-017-4628-3"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.7588"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/00041433-200308000-00003"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2009.126029"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.20.5.1215"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.119.014708","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T08:00:50Z","timestamp":1715587250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.119.014708"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,21]]},"references-count":42,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,1,21]]}},"alternative-id":["10.1161\/JAHA.119.014708"],"URL":"https:\/\/doi.org\/10.1161\/jaha.119.014708","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,21]]},"assertion":[{"value":"2019-10-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e014708"}}