Natriuretic peptides in the monitoring of anthracycline induced reduction in left ventricular ejection fraction.
BACKGROUND
The use of anthracyclines in treatment of cancer is limited by cardiotoxicity of these compounds and may lead to heart failure. Therefore monitoring of cardiac function is necessary during therapy.


OBJECTIVE
We evaluated the value of natriuretic peptides (N-terminal pro-atrial natriuretic peptide (N-ANP) and brain natriuretic peptide (BNP)) for monitoring and predicting anthracycline induced cardiotoxicity using radionuclide left ventricular ejection fraction (EF) measurements as reference.


RESULTS
A total of 107 consecutive patients receiving anthracycline as part of their chemotherapy for malignant disease were studied. Plasma concentrations of the peptides were measured by radioimmunoassay and EF by radionuclide cardiography. For reduced EF values, i.e. below 0.50 a fairly strong correlation was found between N-ANP or BNP and EF. Of 48 patients with serial EF and peptide measurements, 19% showed a significant EF decrease (>0.10) and ended with a final EF value below 0.50. Baseline EF was no predictor of a change in EF during treatment. Neither baseline levels of N-ANP or BNP nor a change in the same variables during therapy were predictive of a change in EF.


CONCLUSIONS
In spite of correlations between peptide concentrations and reduced EF values neither baseline values nor serial measurements can safely substitute EF monitoring in patients undergoing anthracycline therapy.
Daugaard
Gedske
G
Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen Ø, Denmark. gedske@rh.dk
Lassen
Ulrik
U
Bie
Peter
P
Pedersen
Erling Bjerregaard
EB
Jensen
Kaare Troels
KT
Abildgaard
Ulrik
U
Hesse
Birger
B
Kjaer
Andreas
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015251:Epirubicin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D013318:Stroke Volume / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects*
D000903:Antibiotics, Antineoplastic; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D015251:Epirubicin; D009320:Atrial Natriuretic Factor