Use of natriuretic peptides for detecting cardiac dysfunction in long-term disease-free breast cancer survivors.
BACKGROUND
Plasma natriuretic peptides are increased in patients with cardiac dysfunction. N-terminal (NT-ANP) and B-type (BNP) natriuretic peptides were measured in disease-free breast cancer survivors, during long-term follow-up after epirubicin (360 mg/m2 or 450 mg/m2 cumulatively) and chest irradiation.


METHODS
Plasma samples for natriuretic peptide measurement were repeated after extended follow-up in 54 patients, who had participated in 2 studies evaluating cardiotoxicity.


RESULTS
From a median follow-up of 2.7 to 6.5 years, median BNP was raised almost three-fold (p<0.001). Symptomatic heart failure was now present in 2 patients. Compared to the epirubicin 360 mg/m2 group, BNP was higher (p=0.006) in the 450 mg/m2 group, with a trend (p=0.054) for higher NT-ANP.


CONCLUSIONS
These findings suggest that anticancer therapy initiates an autonomically progressive process that may ultimately lead to symptomatic cardiac dysfunction, years after treatment. BNP measurement may be of value to identify patients requiring intensive cardiac follow-up.
Perik
P J
PJ
Department of Medical Oncology, Thorax Centre, University Medical Center Groningen, Groningen, The Netherlands.
De Vries
E G E
EG
Boomsma
F
F
van der Graaf
W T A
WT
Sleijfer
D T
DT
van Veldhuisen
D J
DJ
Gietema
J A
JA
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006331:Heart Diseases / Q000097:blood* / Q000139:chemically induced / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*
D000903:Antibiotics, Antineoplastic; D020097:Natriuretic Peptide, Brain; D015251:Epirubicin; D009320:Atrial Natriuretic Factor; D003520:Cyclophosphamide; D005472:Fluorouracil