title: NT-proBNP as early marker of subclinical late cardiotoxicity after doxorubicin therapy and mediastinal irradiation in childhood cancer survivors.
abstract: BACKGROUND
  Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity.
  
  
  OBJECTIVE
  To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation.
  
  
  METHODS
  A cross-sectional study on 58 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols and 32 asymptomatic Hodgkin's lymphoma survivors who received anthracycline and mediastinal irradiation. Levels of NT-proBNP, TDI, and conventional echocardiography were determined.
  
  
  RESULTS
  Thirty percent of survivors had abnormal NT-proBNP levels. It was significantly related to age at diagnosis, duration of follow-up, and cumulative dose of doxorubicin. TDI detected myocardial affection in 20% more than conventional echocardiography. Furthermore, abnormalities in TDI and NT-pro-BNP levels were more common in Hodgkin lymphoma survivors receiving both chemotherapy and radiotherapy.
  
  
  CONCLUSIONS
  TDI could detect early cardiac dysfunction even in those with normal conventional echocardiography. Measurement of NT-proBNP represents an interesting strategy for detecting subclinical cardiotoxicity. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity.
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
authors.forename: Amal
authors.initials: A
authors.lastname: Zidan
authors.affiliation: Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
authors.forename: Laila M
authors.initials: LM
authors.lastname: Sherief
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
authors.forename: Amera
authors.initials: A
authors.lastname: El-sheikh
authors.affiliation: Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
authors.forename: Safaa H
authors.initials: SH
authors.lastname: Saleh
authors.affiliation: Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
authors.forename: Doaa A
authors.initials: DA
authors.lastname: Shahbah
authors.affiliation: Pediatric Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt.
authors.forename: Naglaa M
authors.initials: NM
authors.lastname: Kamal
authors.affiliation: Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
authors.forename: Hanan S
authors.initials: HS
authors.lastname: Sherbiny
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
authors.forename: Heba
authors.initials: H
authors.lastname: Ahmad
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D066126:Cardiotoxicity / Q000097:blood / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000209:etiology; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004317:Doxorubicin