Preliminary study on behaviour of atrial natriuretic factor in anthracycline-related cardiac toxicity.
The atrial natriuretic factor (ANF) plays an important role in the pathogenesis of congestive heart failure (CHF), by influencing electrolyte and water balance and by modifying peripheral vascular resistance, thus affecting left ventricular performance. Anthracycline derivatives are glycoside antibiotics, active against a wide spectrum of tumours. It is well known that acute and severe dose-related delayed cardiotoxicity constitutes the major limitation to their optimal use. A total of 26 female patients (mean age 53 years) undergoing monochemotherapy for advanced breast cancer, were studied. 4'-Epidoxorubicin (Epidx) 120 mg/m2 intravenously was administered every three weeks for a total of a mean of 6.6 therapeutic cycles (3 to 10). Left ventricular ejection fraction (LVEF) determined by radionuclide ventriculography and circulating ANF were measured periodically in all patients. Epidx administration was limited at a cumulative dose ranging between 840 and 1200 mg/m2 because of a 25% decrease in LVEF and due to a progressive rising in ANF plasma levels. Furthermore, two patients who presented clinical symptoms of CHF had also significantly increased ANF levels (56 and 49% respectively). The current evidence suggests an important pathophysiological role of ANF in anthracyclinic related CHF. Hopefully measurement of plasma ANF will provide a simple non-invasive method of assessing ventricular dysfunction related to anthracycline cardiac toxicity and might represent an additional objective indicator of the severity of haemodynamic compromise in patients with impaired cardiac function.
Neri
B
B
Department of Internal Medicine IV, Oncological Day-Hospital, University of Florence, Italy.
De Scalzi
M
M
De Leonardis
V
V
Gemelli
M T
MT
Ghezzi
P
P
Pacini
P
P
D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood / Q000502:physiology*; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy; D009202:Cardiomyopathies / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D015251:Epirubicin / Q000633:toxicity; D005260:Female; D006801:Humans; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects
D015251:Epirubicin; D009320:Atrial Natriuretic Factor