N-Terminal Pro-B-Type Natriuretic Peptide after High-Dose Chemotherapy: A Marker Predictive of Cardiac Dysfunction?

Abstract

Background: Chronic cardiac dysfunction may develop after administration of aggressive chemotherapy, sometimes leading to development of congestive heart failure (CHF). Recently, N-terminal pro-B-type natriuretic peptide (NT-proBNP) was implicated as a marker of CHF. In this study we evaluated the predictive role of NTproBNP in patients treated with high-dose chemotherapy (HDC). Methods: NT-proBNP was measured after 62 chemotherapy treatments in 52 patients affected by aggressive malignancies. Blood samples were drawn before the start of HDC, at the end of HDC administration, and 12, 24, 36, and 72 h thereafter. In these patients, echocardiograms were performed regularly during a 1-year followup. Results: Seventeen patients (33%) had persistently increased NT-proBNP, 19 patients (36%) had only transient increases (concentrations went back to baseline at 72 h), and 16 (31%) had no increases [mean (SD) values

Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity

“…For instance, a single baseline NT-proBNP level of 900 pg/ml or more was associated with a higher risk of death from any cause in lymphoma patients treated with chemotherapy [52]. Evidences advocating the interest of natriuretic peptides monitoring during the course of chemotherapy exist [53][54][55][56]. A persistently increased NT-proBNP (early after high-dose chemotherapy administration) is predictive of subsequent LV dysfunction during follow-up [53,55].…”

“…Evidences advocating the interest of natriuretic peptides monitoring during the course of chemotherapy exist [53][54][55][56]. A persistently increased NT-proBNP (early after high-dose chemotherapy administration) is predictive of subsequent LV dysfunction during follow-up [53,55]. However, other studies found no correlation between natriuretic peptide increase and development of cardiac dysfunction in patients receiving anthracycline-based chemotherapy [57].…”

“…Natriuretic peptides are strong predictors of elevated LV pressure and HF. For subclinical LV dysfunction detection during cancer therapy, data is inconsistent but it appears that the persistence of NT-proBNP elevation during follow-up identifies patients at higher risk of LVEF decline [53,55].…”

Biomarkers of Cardiac Injury in Detection of Cardiotoxicity Induced by Chemotherapeutic Agents

“…The results of some studies suggested that natriuretic peptides could be of value in the detection of clinical and subclinical cardiotoxicity of anthracyclines [49][50][51][52][53][54]. Recently published studies reported significant BNP/NTproBNP elevations after HD-CT and hematopoietic cell transplantation (HCT) [55][56][57][58]. Persistent BNP/NT-proBNP elevations early after HD-CT were observed in 33 -47 % patients and were associated with the development of cardiac dysfunction during the follow-up.…”

“…Some authors studied the association and relationship between natriuretic peptides and diastolic LV dysfunction, and others simply checked systolic LV function. However, only a few studies [61][62][63][64][65] evaluated the potential predictive value of natriuretic peptide concentrations to detect the ongoing development of cardiac dysfunction.…”