Levels of NT-proBNP and troponin T in cancer patients - mini-review

BACKGROUND: Natriuretic factors are peptidic substances produced by atrial and ventricular myocardium. Primary stimulus to the synthesis of these factors is intramural pressure of atriums by the increase of venous return during intravascular hypervolemia. They may serve as useful cardiac markers in clinical practice. The elevation of N-terminal fragment of atrial natriuretic peptide is characteristic for cardiac failure. Troponin T is a basic component of muscle and is specific for myocardial cell. It is a marker of myocardial damage, specifically of myocardial infarction. PURPOSE: This paper aims to summarize the current knowledge on levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and their associations with cancer. At present, it is well known that natriuretic peptides may be produced by cancer cells without cardiac failure. While small cell lung cancer is a known producer of natriuretic factor, all oncologic diseases may have a potential to produce these substances. ProBNP synthesis may be stimulated by several pro-inflammatory cytokines, including tumour necrosis factor alpha and some interleukins. The production of pro-inflammatory cytokines has been proven in cancer. The influence of natriuretic factors to proto-oncogenes and cancer cells is considered and cross-reacting antibodies increasing NT-proBNP in paraproteinemias were described. Works discussing extreme elevations of NT-proBNP in terminal cancer patients without symptoms of cardiac failure were previously published. NT-proBNP and troponin T are also markers of myocardial damage during cardiotoxic chemotherapy with anthracyclines. CONCLUSION: NT-proBNP and troponin T can be valuable markers of the prognosis of oncologic diseases regarding not only cardiac damage during chemotherapy but also prognosis and extension of cancer patient lives.