Demissei BG, Hubbard RA, Zhang L, et al. - The longitudinal associations between changes in cardiovascular biomarkers and cancer therapy–related cardiac dysfunction (CTRCD) were investigated in patients with breast cancer treated with cardiotoxic cancer therapy. A prospective cohort of 323 patients treated with anthracyclines and/or trastuzumab was longitudinally assessed for repeated measures of high-sensitivity cardiac troponin T (hs-cTnT), NT-proBNP (N-terminal pro-B-type natriuretic peptide), myeloperoxidase, placental growth factor, and growth differentiation factor 15. A follow-up of over a maximum of 3.7 years with serial echocardiograms was performed. Anthracycline-based regimens were correlated with early increases in all biomarkers. They identified an association between hs-cTnT levels > 14 ng/L at anthracycline completion, and a 2-fold increased CTRCD risk and a modest association between changes in NT-proBNP and left ventricular ejection fraction in the overall cohort; this was most pronounced with sequential anthracycline and trastuzumab (with each NT-proBNP doubling they observed 1.1% decline in left ventricular ejection fraction). Further, there was an association between increases in NT-proBNP and CTRCD. In patients who received sequential anthracycline and trastuzumab, they identified an association of increases in myeloperoxidase with CTRCD. These findings suggest an important role of cardiovascular biomarkers in CTRCD risk prediction in patients with breast cancer who receive cardiotoxic cancer therapy, especially in those managed with sequential anthracycline and trastuzumab therapy.