Key result
NT-proBNP was associated with stage B heart failure in cancer survivors (OR 1.63; 95% CI 1.20-2.22; p=0.002) but had poor discrimination (AUC 0.60-0.64) and low sensitivity (42.7% at >125pg/mL).
Why the study?
Although NT-proBNP is guideline-recommended for screening long-term cancer survivors for stage B heart failure, its utility as a biomarker for subclinical cardiac dysfunction in this population remains unproven.
Does NT-proBNP measurement accurately identify echocardiographic stage B heart failure in asymptomatic long-term cancer survivors?
Cross-Sectional (n=441)
Does NT-proBNP measurement accurately identify echocardiographic stage B heart failure in asymptomatic long-term cancer survivors?
NT-proBNP demonstrates poor discrimination and inadequate sensitivity at conventional thresholds for detecting stage B heart failure in long-term cancer survivors, limiting its utility as a standalone screening tool despite current guideline recommendations.
NT-proBNP has limited screening utility in cancer survivors; challenges ESMO recommendations and leaves open need for superior biomarkers.
Background Long-term cancer survivors are predisposed to asymptomatic cardiac structural and functional abnormalities consistent with stage B heart failure (SBHF). N-terminal pro-B-type natriuretic peptide (NT-proBNP) is guideline-recommended for SBHF evaluation and has been recommended in ESMO guidelines for screening in survivors. However, its utility as a biomarker for subclinical cardiac dysfunction in survivors remains unproven. Purpose To evaluate the diagnostic performance of NT-proBNP for identifying SBHF in long-term cancer survivors. Methods Asymptomatic survivors aged ≥40 years, ≥5 years post-cancer therapy and with at least 1 cardiovascular risk factor underwent NT-proBNP measurement and standard echocardiography. SBHF was defined as diastolic dysfunction, systolic dysfunction (reduced global longitudinal strain [GLS] or left ventricular ejection fraction [LVEF]) or LV hypertrophy (LVH). Multivariable logistic regression assessed associations between NT-proBNP with SBHF phenotypes, adjusting for age, sex, diabetes, blood pressure and antihypertensive medication. Discriminatory performance was evaluated using area under the receiver operating characteristics curve (AUC), with sensitivity and specificity examined across clinically relevant thresholds. Results Among 441 long-term survivors (mean age 65.0±8.9 years, 85.7% female), higher NT-proBNP concentrations were independently associated with SBHF (adjusted 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). Associations with diastolic dysfunction, LVH, and reduced LVEF were not statistically significant. Overall discrimination was poor, with AUCs ranging from 0.60 to 0.64. The conventional threshold of >125pg/mL demonstrated limited sensitivity (42.7%) and specificity (68.2%) for SBHF. Lowering the threshold to >55pg/mL improved sensitivity (82.3%) but substantially reduced specificity (30.3%). Conclusion In long-term cancer survivors, NT-proBNP demonstrates limited discrimination for SBHF and lacks adequate sensitivity at conventional thresholds, restricting its role as a standalone screening strategy for preclinical heart failure in this vulnerable population.
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Soh et al. (2026) conducted a cross-sectional in Stage B heart failure (SBHF) in long-term cancer survivors (n=441). NT-proBNP measurement vs. Standard echocardiography was evaluated on Stage B heart failure (defined as diastolic dysfunction, systolic dysfunction [reduced GLS or LVEF], or LV hypertrophy) (OR 1.63, 95% CI 1.20-2.22, p=0.002). NT-proBNP was associated with stage B heart failure in cancer survivors (OR 1.63; 95% CI 1.20-2.22; p=0.002) but had poor discrimination (AUC 0.60-0.64) and low sensitivity (42.7% at >125pg/mL).
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