Brain natriuretic peptide as a cardiac marker of transient radiotherapy-related damage in left-sided breast cancer patients: A prospective study

Palumbo, Isabella; Palumbo, Barbara; Fravolini, Mario Luca; Marcantonini, M.; Perrucci, Elisabetta; Latini, Marisa; Falcinelli, Lorenzo; Sabalich, I.; Tranfaglia, Cristina; Schillaci, Giuseppe; Mannarino, Elmo; Aristei, Cynthia

doi:10.1016/j.breast.2015.10.004

Cited by 48 publications

(37 citation statements)

References 36 publications

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“…28,29 Palumbo I et al confirmed that BNP could be a useful minimally invasive marker of early RT related cardiac impairment in left sided breast cancer. 30 However, no increase in BNP levels at any time point was observed following RT in our study.…”

contrasting

confidence: 47%

Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy-Induced Cardiac Injury.

Ekici¹,

Çakal²,

Baydar³

et al. 2016

UHOD

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Radiotherapy (RT) of the thorax can damage the pericardium, myocardium, heart valves, and coronary vessels, with the pericardium being the most frequently damaged. The objectives of this study were to evaluate RT-induced left ventricular dysfunction and myocardial injury by measuring cardiac biomarkers, troponin I (TnI) and brain natriuretic peptide (BNP), as well as determin cardiotoxicity and early signs of cardiovascular dysfunction using strain rate imaging (SRI) prior to and following RT. This study included 35 patients diagnosed with thoracic malignancy between January 2011 and October 2013. Of the 35 patients, 22 had left-sided lung cancer and13 had left-sided breast cancer. SRI was performed and TnI and BNP levels were measured prior to and following RT. A total radiation dose of 40-60 Gy (mean, 54.9 ± 8.9 Gy) was applied in lung cancer patients and 50-60 Gy (mean, 51.6 ± 4.9 Gy) was applied in breast cancer patients. No significant difference was observed in TnI or BNP levels prior to and one month following RT. The left ventricular ejection fraction (LVEF) did not differ prior to or after the first month of RT. However, lower right ventricular strain (RVS) and left ventricular strain (LVS) SRI values were detected within the first month following RT. From the results of this study, we conclude that SRI is a sensitive method to detect RT-induced changes in cardiac function that are not typically detected by conventional echocardiographic methods and cardiac biomarkers.Keywords: Radiotherapy, Cardiac toxicity, Strain rate imaging, Left-sided lung cancer, Left ventricular ejection fraction ÖZET Radyoterapiye Bağlı Kardiyak Hasarlanmada Strain Görüntüleme, Troponin-I ve Beyin Natriüretik Peptid Seviyelerinin ÖlçümüRadyoterapi (RT) göğüs bölgesine uygulandığında en çok perikard olmak üzere myokard, kalp damarları ve koroner damarlara zarar verir. Bu çalışmanın amacı RT uygulanmış hastalarda sol ventrikül disfonksiyonunu ve myokard hasarını kardiyak biyobelirteçler, Troponin I (TnI) ve Beyin Natriüretik Peptip (BNP) seviyelerini ölçmek ve erken kardiyovasküler erken belirtileri strain rate görüntüleme (SRG) ile RT öncesi ve sonrası belirlemektir. Bu çalışmaya Ocak 2011 ile Ekim 2013 yılları arasında 35 toraks bölgesi kanseri alındı. Otuz beş hastanın 22'si sol meme kanseri ve 13'ü sol taraf akciğer kanseri idi. SR görüntüleme ve TnI, BNP seviyelerine tedavi öncesi ve sonrası bakıldı. Akciğer kanseri hastalarına 40-60 Gy arası (ortalama, 54.9 ± 8.9 Gy) doz ve meme kanseri hastalarına 50-60 Gy (ortalama, 51.6 ± 4.9 Gy) doz uygulandı. BNP ve TnI seviyelerinde tedavi öncesi ve sonrası istatistiki olarak bir anlamlılık görülmedi. Sol ventrikül ejeksiyon fraksiyonu (SVEF) tedavi öncesi ve tedavi sonrası bir aylık dönemde değişmedi. Fakat, sağ ventrikül gerilimi (SVG) ve sol ventrikül gerilimi (SVG) SRG değerleri tedavi sonrası bir aylık dönemde daha düşük bulundu. Bu çalışmanın sonuçlarına göre, RT hasarının kardiyak fonksiyon üzerindeki erken sonuçlarını tespit etmek konvansiyonel ekokardiyografiye göre S...

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contrasting

confidence: 47%

Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy-Induced Cardiac Injury.

Ekici¹,

Çakal²,

Baydar³

et al. 2016

UHOD

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“…In a study of 30 patients undergoing thoracic radiotherapy with chemotherapy, no significant elevations in troponin, nt-proBNP or creatine kinase-myocardial band (CK-MB) were observed after radiotherapy ( 58 ). However, recent studies suggest BNP may be useful as an acute marker of early radiotherapy-related cardiovascular impairment in left-sided breast cancer patients ( 59 ), and in patients receiving thoracic radiotherapy with high-dose heart exposure ( 59 , 60 ). Nevertheless, the majority of patients receiving greater than 20 Gy to the heart during thoracic radiotherapy did not exhibit increased levels of troponin I ( 60 ).…”

Section: Discussionmentioning

confidence: 99%

Late Effects of Total-Body Gamma Irradiation on Cardiac Structure and Function in Male Rhesus Macaques

et al. 2016

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Heart disease is an increasingly recognized, serious late effect of radiation exposure, most notably among breast cancer and Hodgkin’s disease survivors, as well as the Hiroshima and Nagasaki atomic bomb survivors. The purpose of this study was to evaluate the late effects of total-body irradiation (TBI) on cardiac morphology, function and selected circulating biomarkers in a well-established nonhuman primate model. For this study we used male rhesus macaques that were exposed to a single total-body dose of ionizing gamma radiation (6.5–8.4 Gy) 5.6–9.7 years earlier at ages ranging from ~3–10 years old and a cohort of nonirradiated controls. Transthoracic echocardiography was performed annually for 3 years on 20 irradiated and 11 control animals. Myocardium was examined grossly and histologically, and myocardial fibrosis/collagen was assessed microscopically and by morphometric analysis of Masson’s trichrome-stained sections. Serum/plasma from 27 irradiated and 13 control animals was evaluated for circulating biomarkers of cardiac damage [N-terminal pro B-type natriuretic protein (nt-proBNP) and troponin-I], inflammation (CRP, IL-6, MCP-1, sICAM) and microbial translocation [LPS-binding protein (LBP) and sCD14]. A higher prevalence of histological myocardial fibrosis was observed in the hearts obtained from the irradiated animals (9/14) relative to controls (0/3) (P = 0.04, χ2). Echocardiographically determined left ventricular end diastolic and systolic diameters were significantly smaller in irradiated animals (repeated measures ANOVA, P < 0.001 and P < 0.008, respectively). Histomorphometric analysis of trichrome-stained sections of heart tissue demonstrated ~14.9 ± 1.4% (mean ± SEM) of myocardial area staining for collagen in irradiated animals compared to 9.1 ± 0.9 % in control animals. Circulating levels of MCP-1 and LBP were significantly higher in irradiated animals (P < 0.05). A high incidence of diabetes in the irradiated animals was associated with higher plasma triglyceride and lower HDLc but did not appear to be associated with cardiovascular phenotypes. These results demonstrate that single total-body doses of 6.5–8.4 Gy produced long-term effects including a high incidence of myocardial fibrosis, reduced left ventricular diameter and elevated systemic inflammation. Additional prospective studies are required to define the time course and mechanisms underlying radiation-induced heart disease in this model.

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“…This fluctuation matches the results in the present study. Palumbo et al [6] found significant correlation between radiation dose to the heart and normalized BNP levels (a ratio compared to baseline BNP) up to 1 year after treatment, but no correlations with absolute BNP levels. They also did not find any change in the left ventricle ejection fraction; therefore, any changes in BNP are subclinical and may predict damage [6].…”

Section: Discussionmentioning

confidence: 99%

“…Palumbo et al [6] looked at BNP as a marker of radiotherapy-related damage in left-sided breast cancer patients. They found that BNP increased transiently 6 months after treatment, and decreased 1 year after treatment, but remained above baseline levels [6]. This fluctuation matches the results in the present study.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Cardiac Biomarkers after Chemotherapy and Proton Therapy for Mediastinal Hodgkin Lymphoma

Guzhva

Mendenhall

Morris

et al. 2017

International Journal of Particle Therapy

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Purpose: Late cardiac complications from thoracic radiation of patients with Hodgkin lymphoma are of great concern. The authors investigated whether cardiac biomarkers could identify patients with early cardiac damage from thoracic radiation. Materials and Methods: Following completion of anthracycline-based chemotherapy, 14 patients with stage I-IIIA mediastinal Hodgkin lymphoma were enrolled on an IRBapproved prospective trial and agreed to serum evaluation of troponin, CK-MB, and BNP before beginning radiation, after completing radiation, and every 3 to 6 months for 5 years, during follow-up or until relapse. Results: Among the 14 patients, median follow-up for the entire cohort was 5 years. No evidence in abnormal values in troponin or CK-MB was observed among the patient cohort. BNP levels demonstrated statistically significant higher values at various followup time points. Higher levels of BNP were observed among patients receiving higher anthracycline doses (.250 mg), but not among patients with higher mean heart radiation doses. Conclusions: In the first 5 years after treatment, no rise in CK-MB or troponin was identified. BNP levels significantly increased following treatment, with larger increases among patients who received higher doses of anthracyclines. Further investigation is warranted.

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Brain natriuretic peptide as a cardiac marker of transient radiotherapy-related damage in left-sided breast cancer patients: A prospective study

Cited by 48 publications

References 36 publications

Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy-Induced Cardiac Injury.

Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy-Induced Cardiac Injury.

Late Effects of Total-Body Gamma Irradiation on Cardiac Structure and Function in Male Rhesus Macaques

Evaluating Cardiac Biomarkers after Chemotherapy and Proton Therapy for Mediastinal Hodgkin Lymphoma

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