Natriuretic peptides as markers of cardiotoxicity during doxorubicin treatment for non-Hodgkin's lymphoma

Citation
T. Nousiainen et al., Natriuretic peptides as markers of cardiotoxicity during doxorubicin treatment for non-Hodgkin's lymphoma, EUR J HAEMA, 62(2), 1999, pp. 135-141
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Hematology,"Cardiovascular & Hematology Research
Journal title
EUROPEAN JOURNAL OF HAEMATOLOGY
ISSN journal
0902-4441 → ACNP
Volume
62
Issue
2
Year of publication
1999
Pages
135 - 141
Database
ISI
SICI code
0902-4441(199902)62:2<135:NPAMOC>2.0.ZU;2-W
Abstract
Thirty adult patients with non-Hodgkin's lymphoma who were planned to recei ve up to 8-10 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine an d prednisolone) to a cumulative doxorubicin dose of 400-500 mg/m(2) were st udied to evaluate the value of serial plasma atrial natriuretic peptide (AN P), N-terminal pro-ANP (NT-proANP) and brain natriuretic peptide (BNP) meas urements in the early detection of doxorubicin-induced left ventricular dys function. Plasma levels of natriuretic peptides were measured before every treatment course and 4 wk after the last one. Cardiac function was monitore d with serial radionuclide ventriculography. Twenty-eight patients were eva luable for cardiotoxicity. Clinical heart failure developed in 2 patients ( 7%). Left ventricular ejection fraction (LVEF) decreased from 58.0 +/- 1.3% to 49.6 +/- 1.7% (p<0.001). Plasma levels of ANP increased from 16.4 +/- 1 .3 pmol/l to 22.7 +/- 2.4 pmol/l (p = 0.002), NT-proANP from 288 +/- 22 to 380 +/- 42 pmol/l (p = 0.019) and BNP from 3.3 +/- 0.4 to 8.5 +/- 2.0 pmol/ l (p = 0.020). There was a significant correlation between the increase in plasma ANP and the decrease in LVEF (r = -0.447, p = 0.029), and a trend to wards significance between the increase in NT-proANP and the decrease in LV EF (r = -0.390, p = 0.059). The decrease in LVEF started very early and cou ld already be seen after the cumulative doxorubicin dose of 200 mg/m(2), wh ereas the increase in plasma natriuretic peptides was not evident until the cumulative doxorubicin dose of 400 mg/m(2). Our results show that neuroend ocrine activation - increased concentrations of plasma natriuretic peptides - occurs when left ventricular function has reduced substantially and its compensatory capacity has been exceeded resulting in atrial and ventricular overload. Thus, serial natriuretic peptide measurements cannot be used in predicting the impairment of left ventricular function. On the other hand, our study suggests that natriuretic peptides are useful in the detection of subclinical left ventricular dysfunction in patients receiving doxorubicin therapy.