June 2, 2005Clinical Chemistry247 citationsOpen Access
View Full PaperN-Terminal Pro-B-Type Natriuretic Peptide after High-Dose Chemotherapy: A Marker Predictive of Cardiac Dysfunction?
Key Result
Persistently increased NT-proBNP early after high-dose chemotherapy was strongly associated with a significant worsening of left ventricular ejection fraction (from 62.8% to 45.6%; P<0.0001).
Study Design
Type
Cohort (n=52)
Structured PICO
Does persistently increased NT-proBNP after high-dose chemotherapy predict the development of cardiac dysfunction in patients with aggressive malignancies?
P
Population
52 patients affected by aggressive malignancies undergoing 62 high-dose chemotherapy treatments
I
Intervention
Measurement of NT-proBNP (persistently increased vs transiently increased vs no increase)
O
Outcome
Development of cardiac dysfunction (worsening of left ventricular diastolic indexes and left ventricular ejection fraction) at 1-year follow-upsurrogate
Persistently increased NT-proBNP early after high-dose chemotherapy is strongly associated with the development of cardiac dysfunction at 1 year, serving as a potential marker for cardiotoxicity.
Main Result
p-value: p=<0.0001
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 NT-proBNP 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 follow-up. 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 at 72 h, 1163 (936) ng/L vs 185 (101) ng/L vs 39 (19) ng/L, respectively; P <0.0001. Only patients with persistently increased NT-proBNP had a significant worsening of the left ventricular diastolic indexes from baseline to 12 months ratio of peak early to peak late flow velocities from 1.42 (0.33) to 0.78 (0.11); P <0.0001; isovolumetric relaxation time from 90 (15) to 141 (26) ms; P <0.0001; E-wave deceleration time from 162 (17) to 224 (32) ms; P = 0.0004 and of the left ventricular ejection fraction from 62.8 (3.4)% to 45.6 (11.5)%; P <0.0001. CONCLUSIONS: Persistently increased NT-proBNP early after administration of HDC is strongly associated with development of cardiac dysfunction. This finding has important implications for identifying patients at risk of developing chemotherapy-induced cardiotoxicity.