Skip to main content Skip to main navigation menu Skip to site footer

Role of angiotensin-converting enzyme inhibitors on changes in troponin levels in breast cancer with anthracycline chemotherapy

  • Adi Rizka ,
  • Heru Purwanto ,
  • M. Bachtiar Budianto ,
  • Mohammad Saifur Rohman ,

Abstract

Introduction: Breast cancer is the most common type of cancer among women throughout the world. The anthracycline is widely used in the treatments of this cancer. Although it is very effective, its usage is limited due to side effects, such as heart failure. Angiotensin-converting enzyme inhibitors (ACEi) have been reported to delay the process of left ventricular (LV) dysfunction in several clinical trials. This study assesses the role of ACEi in the alteration of troponin levels in breast cancer patients treated in anthracycline chemotherapy.

Methods: This research was a clinical trial Quasi-experimental design that has a control group, whereas the treatment group is purposively determined. The treatment group received with anthracycline chemotherapy plus ACEi, and the ACEi were given before chemotherapy until to 3rd cycle of chemotherapy. Initial troponin levels of the patients were measured pre- and post-treatment, whereas the sample size was determined by calculating via the equation from 15 people each group.

Results: The administering of ACEi could prevent increasing troponin levels by an average of 0.1133 ng/dl from 0.120 ± 0.077 ng/dl to 0.233 ± 0.219 ng/dl, with a p-value = 0.014. Delta Troponin's in Mann-Whitney test value has a p-value of 0.021, so it can be concluded that there is a significant difference between control and treatment group in Delta Troponin, in which the value of control has fewer number than the control treatment.

Conclusion: The treatment group that received the ACEi intervention could prevent an increase of troponin levels after chemotherapy. Overall, it can be concluded that the consumption ACEi can inhibit the rise of Troponin.

References

  1. Susnjar S, Stamatovic L, Gavrilovic D, Minic I, Ursulovic T. The influence of breast cancer subtypes on response to anthracycline neoadjuvant chemotherapy in locally advanced breast cancer patients. The Breast. 2017;32:S81–2. Available from: http://dx.doi.org/10.1016/s0960-9776(17)30266-7
  2. Seifter EJ. Cancer: Principles and Practice of Oncology, 5th Edition Vincent T. DeVita, Jr., Samuel Hellman, Steven A. Rosenberg, eds. Philadelphia:Lippincott-Raven Publishers, 1997.3125 pp. ISBN 0-397-51573-4. JNCI J Natl Cancer Inst. 1997;89(6):353. Available from: http://dx.doi.org/10.1093/jnci/89.6.353
  3. Chakraborty B. The Utility of Pro-inflammatory Cytokines-TNF Alpha and CRP as Indicators of Response to Chemotherapy in Patients with Breast Carcinoma. J Mol Biomark Diagn. 2014;05(03). Available from: http://dx.doi.org/10.4172/2155-9929.1000173
  4. Cardinale D, Sandri MT, Martinoni A, Tricca LabTech A, Civelli M, Lamantia G, et al. Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J Am Coll Cardiol. 2000;36(2):517–22. Available from: http://dx.doi.org/10.1016/s0735-1097(00)00748-8
  5. Wouters KA, Kremer LCM, Miller TL, Herman EH, Lipshultz SE. Protecting against anthracycline-induced myocardial damage: a review of the most promising strategies. Br J Haematol. 2005;131(5):561–78. Available from: http://dx.doi.org/10.1111/j.1365-2141.2005.05759.x
  6. SOLVD study group. Effect of Enalapril on Mortality and the Development of Heart Failure in Asymptomatic Patients with Reduced Left Ventricular Ejection Fractions. N Engl J Med. 1992;327(10):685–91. Available from: http://dx.doi.org/10.1056/nejm199209033271003
  7. Jensen B V, Skovsgaard T, Nielsen SL. Treatment with angiotensin-converting-enzyme inhibitor for epirubicin-induced dilated cardiomyopathy. Lancet. 1996;347(8997):297–9. Available from: http://dx.doi.org/10.1016/s0140-6736(96)90469-9
  8. Adamcová M, Šterba M, Šimunek T, Potácová A, Popelová O, Mazurová Y, et al. Troponin as a marker of myocardiac damage in drug-induced cardiotoxicity. Expert Opin Drug Saf. 2005;4(3):457–72. Available from: http://dx.doi.org/10.1517/14740338.4.3.457
  9. Sparano JA, Brown DL, Wolff AC. Predicting Cancer Therapy-induced Cardiotoxicity. Drug Saf. 2002;25(5):301–11. Available from: http://dx.doi.org/10.2165/00002018-200225050-00001
  10. Merlini L, Nicoletti L, Magaz M, Benvenuto GM, Fortunato A, Morandi P, et al. P25 Use of N-terminal brain natriuretic peptide as a predictive marker for chemotherapy-induced cardiotoxicity. The Breast. 2005;14:S21. Available from: http://dx.doi.org/10.1016/s0960-9776(05)80064-5
  11. Herman EH, Lipshultz SE, Ferrans VJ. The Use of Cardiac Biomarkers to Detect Myocardial Damage Induced by Chemotherapeutic Agents. Cardiac Markers. Humana Press; p. 87–110. Available from: http://dx.doi.org/10.1385/1-59259-385-2:87
  12. Cardinale D, Colombo A, Lamantia G, Colombo N, Civelli M, De Giacomi G, et al. Anthracycline-Induced Cardiomyopathy. J Am Coll Cardiol. 2010;55(3):213–20. Available from: http://dx.doi.org/10.1016/j.jacc.2009.03.095
  13. Lenneman CG, Sawyer DB. Cardio-Oncology. Circ Res. 2016;118(6):1008–20. Available from: http://dx.doi.org/10.1161/circresaha.115.303633
  14. Lou H, Kaur K, Sharma AK, Singal PK. Adriamycin-induced oxidative stress, activation of MAP kinases and apoptosis in isolated cardiomyocytes. Pathophysiology. 2006;13(2):103–9. Available from: http://dx.doi.org/10.1016/j.pathophys.2006.02.004
  15. Lopez-Sendon J, Swedberg K, McMurray J, Tamargo J, Maggion AP, Dargie H. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular diseaseThe Task Force on ACE-inhibitors of the European Society of Cardiology. Eur Heart J. 2004;25(16):1454–70. Available from: http://dx.doi.org/10.1016/j.ehj.2004.06.003
  16. Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2017;6:2048004016687211–2048004016687211. Available from: https://pubmed.ncbi.nlm.nih.gov/28286646

How to Cite

Rizka, A., Purwanto, H., Budianto, M. B., & Rohman, M. S. (2021). Role of angiotensin-converting enzyme inhibitors on changes in troponin levels in breast cancer with anthracycline chemotherapy. Bali Medical Journal, 10(2), 728–732. https://doi.org/10.15562/bmj.v10i2.2354

HTML
1

Total
13

Share

Search Panel