January - March 2015, Volume 11, Issue 1

Bisoc A, Radoi M, Pascu AM

N-Terminal Pro-Brain Natriuretic Peptide in the Early Diagnosis of Anthracycline-Induced Cardiomyopathy

Acta Endo (Buc) 2015, 11 (1): 39-45
doi: 10.4183/aeb.2015.39

Background. Early prediction of anticancer therapy cardiotoxicity is essential for applying proper preventive and supporting therapeutic strategies. Objective. To evaluate plasma N-terminal fragment of pro-brain natriuretic peptide(NT-proBNP) related to cardiac dysfunction assessed by transthoracic 2 D echocardiography (2D-TTE) in patients with cancer and early onset asymptomatic anthracycline-induced cardiomyopathy(AIC). Methods. Prospective study of 68 patients with cancer treated with anthracyclines, followed up for 6 months. Diagnosis of AIC was set at 6 months by decreasing of left ventricular ejection fraction(LVEF) below 50% or with more than 10 units or 20% from baseline. NT-proBNP and 2D-TTE were assessed at enrollment, and thereafter at 3 and 6 months. Results. Fifteen(22.1%) patients developed AIC at 6 months of anthracycline treatment (group 1), and 53(77.95%) patients did not evolve with AIC (group 2). At 3 months, in patients from group 1 NT pro-BNP was significantly higher compared to group 2 [121.0 (119.8;140.8) pg/mL vs. 97.7(75.5;111.7) pg/mL, P=0.0001, values expressed as median (25th; 75th percentiles)]. Left ventricular(LV) diastolic dysfunction was significantly more frequent in group 1(93.3%) vs. group 2(37.7%), P=0.0002. NT-proBNP at 3 months proved accurate in predicting asymptomatic AIC at 6 months [area under the receiver operating characteristic curve(AUC)=0.845, 95%Confidence Interval(CI): 0.735-0.954, P=0.0001]. Newinstalled diastolic dysfunction at 3 months had a sensitivity of 60 %, a specificity of 77% in predicting AIC at 6 months. NT-proBNP assessed at 3 months above a cut-off=118.5pg/ mL was an independent predictor of AIC at 6 months. Conclusions. Plasma NT-proBNP at 3 months of anthracycline therapy proved to be an early independent predictor of asymptomatic anthracycline-induced cardiomyopathy.

Keywords: anthracycline-induced cardiomyopathy, NT-proBNP, diastolic dysfunction, left atrial remodeling.

Correspondence: Alina Mihaela Pascu MD, Transilvania University of Brasov, Faculty of Medicine, str. Nicolae Balcescu nr. 56 (Corp K),etaj II, K II 13., Brasov, 500019, Romania, E-mail: a10pascu@yahoo.com