title: The N-terminal pro-brain natriuretic peptide as a marker of mitoxantrone-induced cardiotoxicity in multiple sclerosis patients.
abstract: OBJECTIVE
  Mitoxantrone (MTX) has been shown to reduce progression of disability and number of clinical exacerbations in patients with progressive multiple sclerosis (MS). Prolonged administration of MTX, however, is limited by the risk of cardiotoxicity. Cardiac monitoring in MTX-treated patients includes usually measurement of left ventricular ejection fraction (LVEF) by means of echocardiography. The N-terminal pro-brain natriuretic peptide (NT-proBNP) represents a novel diagnostic tool in the assessment of heart failure. This study was aimed to evaluate the usefulness of NT-proBNP for early detection of MTX-induced cardiotoxicity in MS patients.
  
  
  METHODS
  We measured the NT-proBNP plasma levels in 45 MS patients who completed 24-month MTX therapy and in 37 MS patients of control group.
  
  
  RESULTS
  The median NT-proBNP plasma value was 15.12pg/mL. In 12 MTX-treated patients (27%), NT-proBNP plasma values were elevated, though this subgroup of patients neither clinical showed evidence of myocardial damage nor had the LVEF value <50%. In five patients with normal NT-proBNP, we observed LVEF decline >10%. We did not observe correlations between the NT-proBNP levels and patient age, MS duration, relapses index, Extended Disability Status Scale (EDSS), MTX single dose and the total cumulative dose of MTX. In 8 patients (22%) from control group, NT-proBNP plasma levels were also elevated.
  
  
  CONCLUSIONS
  The results of our study confirm that MTX therapy is safe for carefully selected and closely monitored MS patients. We believe that serial evaluation of NT-proBNP levels (before, during and after MTX therapy) can identify MS patients at high risk for MTX-induced cardiotoxicity.
authors.affiliation: Department of Neurology, Warsaw Medical University, Warsaw, Poland. Electronic address: apodlecka@wum.edu.pl.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Podlecka-Piętowska
authors.affiliation: Department of Cardiology, Warsaw Medical University, Warsaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochanowski
authors.affiliation: Department of Neurology, Warsaw Medical University, Warsaw, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Zakrzewska-Pniewska
authors.affiliation: Department of Cardiology, Warsaw Medical University, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.affiliation: Department of Neurology, Warsaw Medical University, Warsaw, Poland.
authors.forename: Hubert
authors.initials: H
authors.lastname: Kwieciński
authors.affiliation: Department of Neurology, Warsaw Medical University, Warsaw, Poland.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Kamińska
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000633:toxicity; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D006333:Heart Failure / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects* / Q000633:toxicity; D009103:Multiple Sclerosis / Q000188:drug therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D008942:Mitoxantrone
keywords: Cardiotoxicity; Mitoxantrone; Multiple sclerosis; N-terminal pro-brain natriuretic peptide