Elevated B-type natriuretic peptide levels after anthracycline administration.
BACKGROUND
Cardiotoxicity leading to congestive heart failure is a complication of the anthracyclines. Biochemical methods to diagnose and monitor cardiac function after anthracycline administration would be most useful. We examined the diagnostic role of B-type natriuretic peptide (BNP), a potent biochemical marker of left ventricular dysfunction, in patients administered anthracyclines.


METHODS
Twenty-seven consecutive patients receiving anthracyclines were investigated by serial measurements of BNP levels and other cardiac neurohormones (A-type natriuretic peptide, renin, aldosterone, angiotensin II, norepinephrine, and epinephrine) and myocardial markers (creatine kinase-MB and myosin light chain). Echocardiography was done to assess systolic (ejection fraction) and diastolic (mitral inflow A/E ratio) functions.


RESULTS
Of the examined cardiac biochemical markers, BNP levels alone showed marked elevations to abnormal levels after anthracycline administration. Most patients showed transient increases (peak at 3 to 7 days). Patients with persistent elevations showed a poor prognosis. A/E ratio also correlated with increases in BNP levels in selected patients, which may suggest that raised BNP levels are reflective of induced diastolic dysfunction.


CONCLUSIONS
Our studies suggest the possible use of BNP levels to assess the cardiac state after anthracycline administration. BNP levels most likely reflect cardiac tolerance to the cardiotoxic agent. Serial BNP profiles also suggest persistent elevations to be associated with potentially decompensatory states in contrast to tolerable transient increases. Diagnosis of degree of cardiac tolerance by response to drug administration may be analogous to use of stress testing (exercise) to help define underlying left ventricular dysfunction.
Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan. torusuzu-tky@umin.ac.jp
T
T
Suzuki
D
D
Hayashi
T
T
Yamazaki
T
T
Mizuno
Y
Y
Kanda
I
I
Komuro
M
M
Kurabayashi
K
K
Yamaoki
K
K
Mitani
H
H
Hirai
R
R
Nagai
Y
Y
Yazaki
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D003971:Diastole / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D019337:Hematologic Neoplasms / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis
D000903:Antibiotics, Antineoplastic; D009419:Nerve Tissue Proteins; D020097:Natriuretic Peptide, Brain