BNP as a marker for early prediction of anthracycline‑induced cardiotoxicity in patients with breast cancer

Abstract

Anthracycline chemotherapy serves an important role in treating patients with breast cancer but is associated with cardiotoxicity. Although brain natriuretic peptide (BNP) is not the ideal marker for detecting the presence of diseases of the heart, several studies have demonstrated the predictive utility of BNP in the diagnosis of anthracycline-induced cardiotoxicity (AIC). The aim of the present study was to evaluate the role of BNP as a marker for the early prediction of AIC in patients with breast cancer. In the present study, a total of 149 patients with breast cancer who received anthracycline therapy were evaluated. The levels of BNP and echocardiography were detected during the anthracycline-based chemotherapy and patients were followed up after chemotherapy to determine the cardiotoxicity-free survival times. In the patients who received chemotherapy, an increase in the levels of BNP was observed. The concentration of BNP was significantly higher in the cardiotoxicity group during anthracycline chemotherapy (P=0.022) compared with the non-cardiotoxicity group and it was an independent predictor of cardiotoxicity (P=0.028). The optimal diagnostic threshold of BNP after the last anthracycline chemotherapy treatment was 107.9 pg/ml, the diagnostic sensitivity was 0.538, the specificity was 0.794, the Youden index was 0.332, the positive predictive value was 0.583 and the negative predictive value was 0.762. Based on the BNP threshold, a log-rank test was performed and it was determined that the cardiotoxicity-free survival rate of the group with higher levels of BNP was always lower compared with the group with lower levels of BNP. BNP elevation was associated with cardiotoxicity during the anthracycline chemotherapy. Detecting BNP after the final treatment of anthracycline chemotherapy may contribute to the early detection of cardiotoxicity.

Role of alpha-lipoic acid in counteracting paclitaxel- and doxorubicin-induced toxicities: a randomized controlled trial in breast cancer patients

“…Conflicting data were reported about the effects of alpha-lipoic acid on brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), and neurotensin. It has been demonstrated that there was an elevation in BNPlevel during treatment with doxorubicin [ 38 ] and ALA can ameliorate doxorubicin-associated cardiotoxicity [ 22 ] and can reduce cardiovascular events in patients on hemodialysis [ 39 ]. In contrast, a previous study revealed that there was no significant difference in BNP level between ALA group and the control group 12 months after treatment in patients with a previous experience of transient takotsubo cardiomyopathy [ 37 ].…”

Assessment of the Dynamics of Oxidative Stress Indicators and Early Markers of Myocardial Damage and Dysfunction in Patients with Aggressive Lymphoproliferative Diseases During of Anticancer Therapy

“…При этом связь динамики уровня NT-proBNP с проведением противоопухолевой терапии изучена недостаточно. Установлено повышение концентрации NT-proBNP у пациентов, в лечении которых использовались антрациклины [11,12]. Однако до настоящего времени не выработано единое мнение о возможности использования этого маркера с целью оценки и прогноза кардиотоксичности химиотерапии у онкогематологических больных, поскольку эти исследования малочисленны.…”

Pediatric AML patients with acute‐onset cardiomyopathy in the setting of Streptococcus viridans bacteremia after anthracyclines

“…However, echocardiograms cannot detect early cardiomyocyte damage and have limited reproducibility and accuracy. That said, strain imaging with echocardiography may show subclinical dysfunction during chemotherapy or sepsis before decline in EF by objectively quantifying myocardial mechanical function 10 . B‐type natriuretic peptide (BNP) has also been suggested for detection of early cardiac dysfunction from anthracyclines.…”

“…Based on research from Lu et al. (2019), 10 BNP elevation may be more sensitive than echocardiogram for predicting cardiotoxicity. COG's new trial (AAML1831) will utilize strain echocardiogram and cardiac markers such as BNP to determine the utility of sensitive measures of cardiac function in predicting cardiotoxicity in children with AML.…”