title: Limitations of N-Terminal Pro-B-Type Natriuretic Peptide in the Diagnosis of Heart Disease among Cancer Patients Who Present with Cardiac or Pulmonary Symptoms.
abstract: OBJECTIVE
  Recognizing heart disease is relevant to oncologists because cancer patients are at an increased risk of cardiac mortality due to shared risk factors and the adverse effects of cancer therapy. This study assessed the extent to which the measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) aids in the diagnosis of heart disease in addition to a history of coronary artery disease and the presence of atrial fibrillation (composite test). The NT- proBNP cutoff value was 100 pg/ml.
  
  
  METHODS
  A series of 583 consecutive cancer patients (68.4 ± 11.0 years) who were referred because of cardiac or pulmonary symptoms prospectively underwent a diagnostic work-up. Heart disease was diagnosed if at least one of the following conditions was present: (a) history of coronary artery disease, (b) atrial fibrillation, (c) impaired left ventricular systolic function, (d) significant valvular disease, (e) pulmonary hypertension, or (f) left ventricular hypertrophy.
  
  
  RESULTS
  Except for (a), all 6 conditions were associated with NT-proBNP >100 pg/ml. The sensitivity/specificity values of the composite test were 0.92/0.50 for any heart disease. Several extracardiac covariates were associated with NT-proBNP >100 pg/ml, which contributed to the low test specificity.
  
  
  CONCLUSIONS
  The low specificity of NT-proBNP limits its value for the diagnosis of heart disease in cancer patients.
authors.affiliation: Departments of Cardiology, Pulmonology and Critical Care Medicine, Radiation Oncology and Medical Oncology, Offenburg Hospital, Offenburg, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Wieshammer
authors.forename: Jens
authors.initials: J
authors.lastname: Dreyhaupt
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.forename: Felix
authors.initials: F
authors.lastname: Momm
authors.forename: Andreas
authors.initials: A
authors.lastname: Jakob
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006349:Heart Valve Diseases / Q000097:blood / Q000175:diagnosis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012107:Research Design; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain