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Serum NT ‐pro BNP in the early detection of doxorubicin‐induced cardiac dysfunction
Author(s) -
Kittiwarawut Annop,
Vorasettakarnkij Yongkasem,
Tanasanvimon Suebpong,
Manasnayakorn Sopark,
Sriuranpong Virote
Publication year - 2013
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/j.1743-7563.2012.01588.x
Subject(s) - ejection fraction , medicine , anthracycline , cardiac function curve , asymptomatic , doxorubicin , cardiotoxicity , heart failure , cardiology , brain natriuretic peptide , breast cancer , natriuretic peptide , chemotherapy , biomarker , cancer , cumulative dose , cardiomyopathy , biochemistry , chemistry
Aim Cardiac dysfunction is a major limitation of anthracycline treatment in cancer patients. There are several useful serum markers in other types of cardiomyopathy, including N‐terminal pro‐brain‐natriuretic peptide ( NT ‐pro BNP) , troponin‐ T and creatine kinase MB isoform. We investigated the potential application of these serum biomarkers in cancer patients receiving treatment with anthracycline. Methods We collected data from 52 female breast cancer patients receiving doxorubicin and cyclophosphamide every 3 weeks for four cycles. Cardiac function evaluations by echocardiography were done at baseline and at the end of the fourth cycle of chemotherapy. Patients’ blood samples were serially measured for cardiac biomarkers. Results The mean cumulative dose of doxorubicin in this study was 237 mg/m 2 . No symptomatic heart failure was detected during the study period. However, there were significant asymptomatic reductions of left ventricular ejection fraction ( LVEF ) from mean ± SD 70.7 ± 6% at baseline to 67.0 ± 5% ( P < 0.001). By clinical toxicity criteria the LVEF decline was grade I in 18% and grade II in 4%. After one dose of chemotherapy, a significant rise of serum NT ‐pro BNP occurred in patients who subsequently developed an LVEF reduction compared with patients with normal LVEF ( P = 0.04). A correlation analysis demonstrated that the reduction of fractional shortening was significantly associated with elevated NT ‐pro BNP ( r = −0.016, P = 0.014). Conclusion Asymptomatic reductions in cardiac function are common in breast cancer patients treated with doxorubicin. NT ‐pro BNP may serve as a convenient serum biomarker for the early detection of cardiotoxicity induced by anthracycline.