The use of natriuretic peptide to screen for stage B heart failure based on echocardiogram among cancer survivors

Background and Aims Heart failure is a progressive disorder that can be identified at earlier stage, also known as stage B heart failure (SBHF). While N-terminal pro-B-type natriuretic peptide (NT-proBNP) was shown to be a key biomarker, its screening performance among cancer survivors remains uncertain. This study aimed to identify the performance of NT-proBNP in identifying SBHF, encompassing both structural and functional abnormalities, in survivors. Methods Survivors ≥5 years post cancer therapy and with ≥1 cardiovascular risk factor were recruited. SBHF was defined as diastolic dysfunction (E/e’ >13 with left atrial volume index >34ml/m2), reduced global longitudinal strain (GLS), reduced left ventricular ejection fraction (LVEF) or left ventricular hypertrophy (LVH). In this predominantly cross-sectional analysis, we analysed the association between NT-proBNP with SBHF, adjusting for age, sex, diabetes, blood pressure and antihypertensive medication. Area under the curve (AUC) was used to assess discrimination of NT-proBNP for SBHF and various thresholds were applied. Results Among 441 long-term survivors (mean age 65.0±8.9 years, 85.7% female), elevated NT-proBNP levels were associated with SBHF (OR 1.63 [95%CI 1.20-2.22], p=0.002) and reduced GLS (adjusted OR 1.81 [1.32-2.50], p<0.001), whereas associations with diastolic dysfunction, LVH, and reduced LVEF were not significant. Discriminatory performances of NT-proBNP for SBHF and its subtypes were poor, with AUCs ranging from 0.60 to 0.64. The conventional threshold (>125pg/mL) demonstrated inadequate sensitivity (42.7%) and specificity (68.2%). Lower thresholds (>55pg/mL) improved sensitivity (82.3%) but reduced specificity (30.3%). Conclusion The poor sensitivity of NT-proBNP for SBHF limits its effectiveness as a standalone screening tool.