Table 2.
Role of natriuretic peptides in the evaluation of chemotherapy and radiation-induced cardiotoxicity.
| Reference | Population | N | Treatment | BNP type | Cutoff | BNP evaluations | Results and conclusions |
|---|---|---|---|---|---|---|---|
| Meinardi et al. (98) | Breast cancer | 39 | ACs and RT | BNP | 10 pmol/l | Baseline, 1 month, and 1 year after chemotherapy | BNP increased as early as 1 month after chemo; no correlation with LVEF decline |
| Nousiainen et al. (99) | Non-Hodgkin lymphoma | 28 | CHOP | BNP | 227 pmol/l | Baseline, after every cycle, and 4 weeks after last cycle | Correlation between BNP increases and parameters of diastolic function (FS and PFR) |
| Daugaard et al. (100) | Various | 107 | ACs | BNP | Before, and at various points during treatment | BNP correlation with decreased LVEF, but baseline and BNP change could not predict LVEF decline | |
| Perik et al. (101) | Breast cancer | 54 | ACs and RT | NT-proBNP | 10 pmol/l | Median 2.7 and 6.5 years after chemotherapy | BNP increased with time and was related to dose; cardiotoxic effects develop over years |
| Sandri et al. (102) | Various | 52 | HDC | NT-proBNP | 153 ng/l (M ≤50), 227 ng/l (M >50), 88 ng/l (F ≤50), 334 ng/l (F >50) | Baseline, and 0, 12, 24, 36, and 72 h after each cycle | Persistent NT-proBNP elevation at 72 h predicts later systolic and diastolic dysfunction |
| Germanakis et al. (103) | Pediatric cancers | 19 | ACs | NT-proBNP | 0.2 pmol/ml | Mean 3.9 years after chemotherapy | Correlation between NT-proBNP and LV mass decrease |
| Perik et al. (70) | Breast cancer | 17 | ACs and T | NT-proBNP | 125 ng/l | Baseline and throughout T treatment | Higher pre-treatment NT-proBNP values in those who developed HF during treatment |
| Aggarwal et al. (104) | Pediatric cancers | 63 | ACs | BNP | Once, >1 year after treatment completion | Higher BNP in patients with late cardiac dysfunction by ECHO | |
| Ekstein et al. (105) | Pediatric cancers | 23 | ACs | NT-proBNP | 350 pg/ml | Before and after each AC dose | Dose-related increase in BNP from baseline seen after first AC dose |
| Jingu et al. (106) | Esophageal cancer | 197 | RT | BNP | Before, <1 month, 1–2, 3–8, 9–24, and >24 months after RT | Increased BNP over time and in those with abnormal FDG accumulation | |
| Kouloubinis et al. (97) | Breast cancer | 40 | ACs | NT-proBNP | Before and after chemotherapy | Correlation between NT-proBNP increase and LVEF decline | |
| Dodos et al. (71) | Various | 100 | ACs | NT-proBNP | 153 or 227 ng/l for M ≤50 or >50; 88 or 334 ng/l for F ≤50 or >50 | After first dose, last dose, and 1, 6, and 12 months after last dose | No significant increase in NT-proBNP with treatment; cannot replace serial ECHO for monitoring of AC-induced cardiotoxicity |
| Kozak et al. (72) | Lung and esophageal CA | 30 | ChemoRT | NT-proBNP | Baseline, after 2 weeks of RT, and after RT end | No change in NT-proBNP during treatment | |
| Cil et al. (73) | Breast cancer | 33 | ACs | NT-proBNP | 110 pg/ml | Before and after chemotherapy | Despite association, pre-chemo NT-proBNP did not predict for later LVEF |
| ElGhandour et al. (96) | Non-Hodgkin lymphoma | 40 | CHOP | BNP | Before first cycle and after sixth cycle of chemotherapy | Correlation between BNP values after chemotherapy and LVEF | |
| Mavinkurve-Groothuis et al. (74) | Pediatric cancers | 122 | ACs | NT-proBNP | 10 pmol/l (M), 18 pmol/l (F), age-adjusted in children (107) | Once, with imaging | NT-proBNP levels related to cumulative AC dose |
| Nellessen et al. (76) | Lung and breast CA | 23 | RT | NT-proBNP | 100 pg/ml | Before RT, every week during RT for 4–6 weeks | Log-transformed NT-proBNP increased during treatment |
| Fallah-Rad et al. (51) | Breast cancer | 42 | ACs and T | NT-proBNP | Before chemotherapy, before T, and 3, 6, 9, and 12 months after start of T | No change in NT-proBNP values over time | |
| Feola et al. (77) | Breast cancer | 53 | ACs | NT-proBNP | 5 pg/ml | Baseline, after 1 month, 1, and 2 years | NT-proBNP increased acutely with treatment, and in patients with systolic dysfunction |
| Goel et al. (78) | Breast cancer | 36 | ACs and T | NT-proBNP | 110 pg/ml (age <75), 589 pg/ml (age >75) | Baseline, before and 24 h after T | No change in NT-proBNP with trastuzumab |
| Romano et al. (80) | Breast cancer | 92 | ACs | NT-proBNP | 153 pg/ml (age ≤50), 222 pg/ml (age >50) | Every 2 weeks during treatment, then at 3, 6, and 12 months | Interval change in NT-proBNP predicated for LV impairment at 3, 6, and 12 months |
| Sawaya et al. (81) | Breast cancer | 43 | ACs and T | NT-proBNP | 125 pg/ml | Baseline, 3 and 6 months after chemotherapy | No relation between NT-proBNP levels before and after treatment and LVEF change |
| D’Errico et al. (82) | Breast cancer | 60 | ChemoRT | NT-proBNP | 125 pg/ml | Before, and after RT | Correlation between NT-proBNP, V3Gy for the heart, and |
| Lipshultz et al. (84) | ALL | 156 | ACs | NT-proBNP | 150 pg/ml (age <1), 100 pg/ml (age ≥1) | Before, and daily during induction, and after treatment | Correlation between NT-proBNP and change in LV thickness-to-dimension ratio 4 years later |
| Mladosievicova et al. (108) | Childhood leukemias | 69 | ACs | NT-proBNP | 105 pg/ml (F), 75 pg/ml (M) | Median 11 years after treatment | Increased NT-proBNP with exposure to ACs |
| Onitilo et al. (85) | Breast cancer | 54 | Taxanes and T | BNP | 200 pg/ml | Baseline, and every 3 weeks during treatment | No correlation between elevated BNP values and cardiotoxicity |
| Pongprot et al. (90) | Pediatric cancers | 30 | ACs | NT-proBNP | Age-adjusted (109) | Once, with imaging | Correlation between NT-pro BNP values and FS and LVEF |
| Sawaya et al. (86) | Breast cancer | 81 | ACs and T | NT-proBNP | 125 pg/ml | Before, every 3 months during, and after T treatment | NT-proBNP did not change with treatment |
| Sherief et al. (87) | Acute leukemias | 50 | ACs | NT-proBNP | Age-adjusted (107) | Once, with imaging | NT-proBNP linked to AC dose and abnormal tissue Doppler imaging parameters |
| Kittiwarawut et al. (110) | Breast cancer | 52 | ACs | NT-proBNP | 45 pg/ml | Baseline, and end of fourth cycle | Correlation between NT-proBNP and FS |
| Ky et al. (89) | Breast cancer | 78 | ACs and T | NT-proBNP | Baseline, 3 and 6 months after start of chemotherapy | No relationship between NT-proBNP values and cardiotoxicity |
BNP, brain natriuretic peptide; NT, N-terminal; AC, anthracycline; RT, radiation therapy; HDC, high-dose chemotherapy; T, trastuzumab; LVEF, left ventricular ejection fraction; HF, heart failure; ALL, acute lymphoblastic leukemia; FS, fractional shortening; PFR, peak filling rate.