NT-proBNP as Early Marker of Subclinical Late Cardiotoxicity after Doxorubicin Therapy and Mediastinal Irradiation in Childhood Cancer Survivors

Abstract

Background. Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity. Aims of the Study. To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation. Methods. A cross-sectional study on 58 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols and 32 asymptomatic Hodgkin's lymphoma survivors who received anthracycline and mediastinal irradiation. Levels of NT-proBNP, TDI, and conventional echocardiography were determined. Results. Thirty percent of survivors had abnormal NT-proBNP levels. It was significantly related to age at diagnosis, duration of follow-up, and cumulative dose of doxorubicin. TDI detected myocardial affection in 20% more than conventional echocardiography. Furthermore, abnormalities in TDI and NT-pro-BNP levels were more common in Hodgkin lymphoma survivors receiving both chemotherapy and radiotherapy. Conclusions. TDI could detect early cardiac dysfunction even in those with normal conventional echocardiography. Measurement of NT-proBNP represents an interesting strategy for detecting subclinical cardiotoxicity. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity.

Role of ACE inhibitors in anthracycline‐induced cardiotoxicity: A randomized, double‐blind, placebo‐controlled trial

“…Cardiac biomarkers such as N‐terminal proBNP, cTnI and cardiac troponin T and CK‐MB have been used to assess cardiotoxicity . Among these, proBNP has shown promise as an early marker of late toxicity, and it also correlates with left ventricular systolic and diastolic function . Toxicity is dose‐ and time dependent, with more toxicity observed in patients receiving higher doses of anthracyclines .…”

Role of Biomarkers in Prediction of Cardiotoxicity During Cancer Treatment

“…As discussed earlier, the utility of troponin in long-term surveillance of cancer survivors seems weak. However, brain natriuretic peptides appear to be potential early indicators of late cardiotoxicity during cancer survivorship as they have been associated with increased LV dimensions and echocardiographic features of systolic and diastolic dysfunction [ 39 – 41 , 56 , 57 , 64 , 65 ].…”

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

“…A number of biomarkers, such as cardiac troponin T (6), fluorouracil (23) and circulating microRNAs (24) have been reported to have a predictive role in identifying AIC. Serum BNP elevation during chemotherapy has also been well investigated (13). The present study focused on monitoring the dynamic variation in serum BNP levels during anthracycline chemotherapy.…”

“…multiple studies demonstrated that serum BNP may be an independent biomarker in detection of cardiotoxicity, however, relatively little known is about the predictive applicability of BNP in anthracycline-treated patients (9)(10)(11)(12)(13). Therefore, the aim of the present study was to assess the potential role of BNP detection in the early prediction of anthracycline-induced cardiotoxicity in patients with breast cancer.…”