Introduction:
Natriuretic peptides (NP) are routinely used for the diagnosis of heart failure. Studies have suggested higher levels of NP in patients with cancer, possibly driven by cancer associated inflammation. This study aims to assess the performance characteristics of natriuretic peptides in predicting invasively measured elevated intracardiac filling pressures in patients with cancer.
Methods:
Patients with cancer who underwent a right heart catheterization (RHC) at a tertiary cancer center from 10/2011 to 10/2021 were identified. Demographic characteristics, NP levels and invasive hemodynamic data were abstracted. Pulmonary capillary wedge pressure (PCWP)
>
15 mmHg and mean right atrial pressure (mRAP)
>
8 mmHg were defined as abnormal.
Results:
Of 1240 patients who underwent a RHC, 740 had NTproBNP (41%) or BNP levels (23%) available within a median of 1 day (0-3, and 0-4 days, respectively) from the procedure. Of those, 46% were female, 70% were white, median age was 67 years (IQR: 58-74) and median BMI was 25.2 kg/m
2
(17.4-30.3). High PCWP was present in 58% of patients while an additional 15% had high mRAP with normal PCWP (73%). The area under the curve (AUC) of NTproBNP and BNP in predicting high PCWP was 0.626 (95% CI 0.578-0.675) and 0.681 (0.617-0.744), respectively. The AUC of NTproBNP and BNP in predicting high PCWP or high mRAP was 0.603 (0.549-0.657) and 0.690 (0.621-0.759), respectively. At 125 pg/ml, NTproBNP had a sensitivity of 95%, specificity 6%, positive predictive value (PPV) 57%, and negative predictive value (NPV) 48% for high PCWP and a sensitivity of 95%, specificity 9%, PPV of 74%, and NPV 41% for high PCWP or high mRAP. At 100 pg/ml, BNP had a sensitivity of 89%, specificity 25%, PPV 64%, and NPV 60% for high PCWP, and a sensitivity of 88%, specificity 28%, PPV 77%, and NPV 47% for high PCWP or high mRAP.
Conclusions:
NP at the standard cutoff levels are very sensitive in predicting elevated intracardiac filling pressures in patients with cancer. However, they can be falsely elevated in >70% of cancer patients with normal filling pressures. These caveats need to be considered when utilizing elevated levels of NP in the assessment of patients with cancer and dyspnea and/or edema.
