OCT 17, 2013 07:00 AM PDT
Monitoring for Chemotherapy Toxicity and Cardiac Troponin
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  • Chair of the Division of Clinical Core Laboratory Services in the Department of Laboratory Medicine , Mayo Clinic College of Medicine
      The focus of Dr. Jaffes research has been the development and implementation clinically of biomarkers of cardiac injury, hemodynamic stress and coagulation in the acute cardiac care setting. Of late his focus has been mostly on markers of cardiac injury and particularly cardiac troponin and to some extent on hemodynamic stress and particularly natriuretic peptides. He has participated in or directed many of the major national and international guidelines initiatives in these areas which include efforts to define the criteria for the diagnosis of acute myocardial infarction. His research activities include a broad range of involvement from basic investigation, assay development, clinical translation and clinical implementation. Publications at each level, usually with collaborators have been developed. At present he has NIH funding as part of a project to define the changing incidence of AMI in the community and to study the use of novel natriuretic peptides in the setting of acute ischemic heart disease. In addition, Dr. Jaffe directs ongoing efforts collecting blood samples on patients who present to the Emergency Department with symptoms compatible with ischemia.

    Recent data have confirmed the ability of cardiac troponin (cTn) measurements to identify those who are developing cardiotoxicity in response to potentially cardiotoxic chemotherapeutic agents. Indeed, in some studies, the use of antioxidant treatments have been shown to reduce the increases in cTn and with that the eventual development of reduced ventricular performance. The next iteration of cardiac troponin assays are substantially more sensitive than conventional assays and thus able to identify problems at a far earlier stage. Indeed, the pharmaceutical industry has been using such testing to determine during the developmental phases of discovery whether or not specific agents might be cardiotoxic. Thus, there is substantial promise that these new assays will facilitate these sorts of evaluations in patients receiving chemotherapy as well. However, these very sensitive assays detect a variety of cardiovascular comorbidities. These include not only coronary artery disease but also structural heart disease. Thus, baseline values will be essential the proper interpretation of subsequent values. In addition, because these assays are sensitive, careful sample acquisition and preparation will be essential and it is likely that sex specific cut off values will be necessary.  Of course, the early detection of cardiotoxicity is only half of the problem. We then will need to figure out how to optimally inhibit this toxicity while making sure we do not negatively impact on the therapy of the cancer itself.

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