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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

High-sensitivity troponin T as a predictor of cardiovascular events in colorectal cancer patients undergoing chemotherapy: results of the COLOVASC prospective cohort study

  • Bence Prohászka1
  • Zsófia Sándor1,2
  • Tamás Ferenci3,4
  • László Gráf1
  • Júlia Lohinszky1
  • Anna Horváth1
  • Bálint Tegze1
  • Katalin Éva Tóth1
  • Tamás Masszi1
  • Zsófia Dóra Drobni2
  • Daniela Maria Cardinale5
  • Zoltán Pozsonyi1
5 affiliations
  1. 1Department of Internal Medicine and Hematology, Semmelweis University
  2. 2Department of Cardiology, Heart and Vascular Center, Semmelweis University
  3. 3Physiological Controls Research Center, Obuda University
  4. 4Department of Statistics, Corvinus University of Budapest
  5. 5Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology IRCCS
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Abstract

Background: Fluoropyrimidine-based chemotherapy is associated with cardiovascular events in patients with colorectal cancer, yet validated tools for pre-treatment cardiovascular risk stratification are lacking. Cardiac biomarkers are not routinely incorporated into baseline assessment and prospective evidence supporting their use remains limited.

Objectives: Our aim was to determine whether baseline high-sensitivity troponin T (hs-TnT) provides prognostic information for major adverse cardiovascular events during chemotherapy in patients with colorectal cancer.

Materials and methods: Within a prospective single-center observational cohort study at the Department of Internal Medicine and Hematology, Semmelweis University, consecutive patients with histologically confirmed newly diagnosed or recurrent colorectal cancer scheduled to receive 5-fluorouracil (5-FU)-based chemotherapy were enrolled between September 1, 2020, and June 2, 2024. Baseline hs-TnT concentrations were measured before treatment initiation, and patients were followed for the occurrence of major adverse cardiovascular events (MACEs). Independent predictors of MACE were identified using penalized multivariable logistic regression. Receiver operating characteristic (ROC) curve analysis evaluated the discriminatory performance of baseline hs-TnT and determined the optimal cut-off value using the Youden index. Adequacy index analysis assessed the relative prognostic contribution of hs-TnT to the multivariable model.

Results: 180 patients were enrolled, with a median follow-up of 185 days, 44 patients (24.4%) experienced MACE, more than half of them occurred within the first two cycles of chemotherapy. Baseline hs-TnT demonstrated modest discrimination for predicting MACE (AUC 0.628, 95% CI 0.513–0.742). The optimal hs-TnT cut-off was 14 ng/L. In a multivariable analysis, elevated baseline hs-TnT (OR 2.35 per +10 ng/L, 95% CI 1.37–4.05) and Vascular Endothelial Growth Factor (VEGF)-inhibitor therapy (OR 2.38, 95% CI 1.23–4.60) were associated with MACEs. In a sensitivity analysis, excluding treatment-related hypertension from the composite endpoints, elevated baseline hs-TnT remained the only independent predictor. According to the adequacy index analysis, hs-TnT contributed 38.3% of the total prognostic information provided by the multivariable model.

Conclusions: Baseline hs-TnT was independently associated with MACEs in patients with colorectal cancer receiving fluoropyrimidine-based chemotherapy. Although its discriminatory performance as a standalone biomarker was modest, hs-TnT provided incremental prognostic information for baseline cardiovascular risk assessment and may help identify patients who warrant closer cardiovascular surveillance.

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Cite

BibTeXRIS
BibTeX
@article{prohaszka2026highsensitivity,
  title = {{High-sensitivity troponin T as a predictor of cardiovascular events in colorectal cancer patients undergoing chemotherapy: results of the COLOVASC prospective cohort study}},
  author = {Bence Prohászka and Zsófia Sándor and Tamás Ferenci and László Gráf and Júlia Lohinszky and Anna Horváth and Bálint Tegze and Katalin Éva Tóth and Tamás Masszi and Zsófia Dóra Drobni and Daniela Maria Cardinale and Zoltán Pozsonyi},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1943142},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1943142/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - High-sensitivity troponin T as a predictor of cardiovascular events in colorectal cancer patients undergoing chemotherapy: results of the COLOVASC prospective cohort study
AU  - Bence Prohászka
AU  - Zsófia Sándor
AU  - Tamás Ferenci
AU  - László Gráf
AU  - Júlia Lohinszky
AU  - Anna Horváth
AU  - Bálint Tegze
AU  - Katalin Éva Tóth
AU  - Tamás Masszi
AU  - Zsófia Dóra Drobni
AU  - Daniela Maria Cardinale
AU  - Zoltán Pozsonyi
PY  - 2026
DA  - 2026/10/13
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1943142
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1943142/full
AB  - Background: Fluoropyrimidine-based chemotherapy is associated with cardiovascular events in patients with colorectal cancer, yet validated tools for pre-treatment cardiovascular risk stratification are lacking. Cardiac biomarkers are not routinely incorporated into baseline assessment and prospective evidence supporting their use remains limited.  Objectives: Our aim was to determine whether baseline high-sensitivity troponin T (hs-TnT) provides prognostic information for major adverse cardiovascular events during chemotherapy in patients with colorectal cancer.  Materials and methods: Within a prospective single-center observational cohort study at the Department of Internal Medicine and Hematology, Semmelweis University, consecutive patients with histologically confirmed newly diagnosed or recurrent colorectal cancer scheduled to receive 5-fluorouracil (5-FU)-based chemotherapy were enrolled between September 1, 2020, and June 2, 2024. Baseline hs-TnT concentrations were measured before treatment initiation, and patients were followed for the occurrence of major adverse cardiovascular events (MACEs). Independent predictors of MACE were identified using penalized multivariable logistic regression. Receiver operating characteristic (ROC) curve analysis evaluated the discriminatory performance of baseline hs-TnT and determined the optimal cut-off value using the Youden index. Adequacy index analysis assessed the relative prognostic contribution of hs-TnT to the multivariable model.  Results: 180 patients were enrolled, with a median follow-up of 185 days, 44 patients (24.4%) experienced MACE, more than half of them occurred within the first two cycles of chemotherapy. Baseline hs-TnT demonstrated modest discrimination for predicting MACE (AUC 0.628, 95% CI 0.513–0.742). The optimal hs-TnT cut-off was 14 ng/L. In a multivariable analysis, elevated baseline hs-TnT (OR 2.35 per +10 ng/L, 95% CI 1.37–4.05) and Vascular Endothelial Growth Factor (VEGF)-inhibitor therapy (OR 2.38, 95% CI 1.23–4.60) were associated with MACEs. In a sensitivity analysis, excluding treatment-related hypertension from the composite endpoints, elevated baseline hs-TnT remained the only independent predictor. According to the adequacy index analysis, hs-TnT contributed 38.3% of the total prognostic information provided by the multivariable model.  Conclusions: Baseline hs-TnT was independently associated with MACEs in patients with colorectal cancer receiving fluoropyrimidine-based chemotherapy. Although its discriminatory performance as a standalone biomarker was modest, hs-TnT provided incremental prognostic information for baseline cardiovascular risk assessment and may help identify patients who warrant closer cardiovascular surveillance.
SN  - 2297-055X
ER  -