Prospective investigation of the significance of cardiac markers, NT-pro Brain Natriuretic Peptide (NT-proBNP) and Troponin T (TnT), in the Hercules study of epirubicin/cyclophosphamide with or without trastuzumab (Herceptin®)

AbstractBackground:Soluble suppression of tumorigenicity 2 (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitive troponin I (hs-TnI), and high sensitive troponin T (hs-TnT) are representative cardiac biomarkers. The reference intervals (RIs) of these biomarkers have been rarely investigated in umbilical cord blood (UCB). We explored the distribution of these cardiac markers and established their RIs in UCB.Methods:In a total of 293 UCB specimens, sST2, NT-proBNP, hs-TnI, and hs-TnT concentrations were analyzed according to the gestational age, presence of premature membrane rupture (PROM), presence of gestational diabetes mellitus (GDM), and Apgar score at 1 min. Their RIs were defined in 133 UCB specimens from healthy, full-term neonates, using non-parametric percentile methods according to the Clinical and Laboratory Standards Institute guideline (EP28-A3C).Results:The concentrations of four cardiac markers in UCB were different between full-term neonates and pre-term neonates. The concentrations of NT-proBNP and hs-TnI differed according to the presence or absence of PROM. Their concentrations did not differ regardless of the presence of GDM. The concentrations of sST2 and NT-proBNP differed according to the Apgar score at 1 min. The 97.5th percentile upper reference limits were: sST2, 59.9 ng/mL; NT pro-BNP, 1415.3 pg/mL; hs-TnI, 27.8 pg/mL; and hs-TnT, 86.5 pg/mL.Conclusions:The distribution of sST2, NT pro-BNP, hs-TnI, and hs-TnT in UCB together with their RIs would provide fundamental data for future researches and clinical practice.

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1518: Troponin T and N-Terminal Pro-Brain Natriuretic Peptide (PRO-BNP) Changes in Patients Undergoing Transurethral Resection of The Prostate (TURP)

The Journal of Urology ◽

10.1016/s0022-5347(18)38726-3 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 399-400

Author(s):

Ramaswamy Manikandan ◽

Calvin Nathaniel ◽

Ravi Gullipalli ◽

Adebanji Adeyoju ◽

Stephen C.W. Brown ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Transurethral Resection ◽

Troponin T

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Combined Measurements of Cardiac Troponin T and N-Terminal Pro-Brain Natriuretic Peptide in Patients With Heart Failure

Circulation Journal ◽

10.1253/circj.68.1160 ◽

2004 ◽

Vol 68 (12) ◽

pp. 1160-1164 ◽

Cited By ~ 30

Author(s):

Ryoji Taniguchi ◽

Yukihito Sato ◽

Tasuku Yamada ◽

Muneo Ooba ◽

Hirokazu Higuchi ◽

...

Keyword(s):

Heart Failure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Cardiac Troponin ◽

Troponin T ◽

Cardiac Troponin T ◽

Patients With Heart Failure ◽

Combined Measurements

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Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide and High-Sensitivity Troponin T Levels in the Natural History of Transthyretin Amyloid Cardiomyopathy and Their Evolution after Tafamidis Treatment

Journal of Clinical Medicine ◽

10.3390/jcm10214868 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4868

Author(s):

Silvia Oghina ◽

Constant Josse ◽

Mélanie Bézard ◽

Mounira Kharoubi ◽

Marc-Antoine Delbarre ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Prognostic Value ◽

Troponin T ◽

High Sensitivity ◽

Relative Increase ◽

High Sensitivity Troponin ◽

Increased Risk ◽

Amyloid Cardiomyopathy ◽

High Sensitivity Troponin T

Background: We assesse the evolution and prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (cTnT-HS) in transthyretin amyloid cardiomyopathy (ATTR-CA) before and after tafamidis treatment. Methods and Results: 454 ATTR-CA patients without tafamidis (Cohort A) and 248 ATTR-CA with tafamidis (Cohort B) were enrolled. Event-free survival (EFS) events were death, heart transplant, or acute heart failure. In Cohort A, 27% of patients maintained NT-proBNP < 3000 ng/L and 14% cTnT-HS < 50 ng/L at 12 months relative to baseline levels. In Cohort B, the proportions were 49% and 29%, respectively. In Cohort A, among the 333 patients without an increased NT-proBNP > 50% relative to baseline EFS was extended compared to the 121 patients with an increased NT-proBNP > 50% (HR: 0.75 [0.57; 0.98]; p = 0.032). In Cohort A, baseline NT-proBNP > 3000 ng/L and cTnT-HS > 50 ng/L and a relative increase of NT-proBNP > 50% during follow-up were independent prognostic factors of EFS. The slopes of logs NT-proBNP and cTnT-HS increased with time before and stabilized after tafamidis. Conclusion: ATTR-CA patients with increasing NT-proBNP had an increased risk of EFS. Tafamidis stabilize NT-proBNP and cTnT-HS increasing, even if initial NT-proBNP levels were >3000 ng/L. Thus suggesting that all patients, irrespective of baseline NT-proBNP levels, may benefit from tafamidis.

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N-terminal pro-brain natriuretic peptide and high-sensitivity troponin T exhibit additive prognostic value for the outcome of critically ill patients

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618768088 ◽

2018 ◽

Vol 9 (5) ◽

pp. 496-503 ◽

Cited By ~ 2

Author(s):

Max Lenz ◽

Konstantin A Krychtiuk ◽

Georg Goliasch ◽

Klaus Distelmaier ◽

Johann Wojta ◽

...

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Brain Natriuretic Peptide ◽

Critically Ill ◽

Natriuretic Peptide ◽

Critically Ill Patients ◽

Plasma Levels ◽

Troponin T ◽

High Sensitivity ◽

The Individual

Background: Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. Methods: We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter. Results: Of the included 148 patients, 52% were male, mean age was of 64.2 ± 16.8 years and 30-day mortality was 33.2%. Non-survivors showed significantly higher NT-proBNP and TnT plasma levels as compared with survivors ( p<0.01). An elevation of both markers exhibited an additive effect on mortality, as those with both NT-proBNP and TnT levels above the median had a 30-day mortality rate of 51.0%, while those with both markers below the median had a 16.7% mortality rate (hazard ratio 3.7). These findings were independent of demographic and clinical parameters ( p<0.05). Conclusions: Our findings regarding the individual predictive properties of NT-proBNP and TnT are in line with literature. However, we were able to highlight that they exhibit additive prognostic potential which exceeds their individual value. This might be attributed to a difference in underlying pathomechanisms and an assessment of synergistic risk factors.

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Abstract 2550: N-terminal Pro-brain Natriuretic Peptide-defined Cardiomyopathy in Doxorubicin-treated Children with Acute Lymphoblastic Leukemia

Circulation ◽

10.1161/circ.116.suppl_16.ii_563-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Steven E Lipshultz ◽

Stuart R Lipsitz ◽

Rebecca E Scully ◽

Tracie L Miller ◽

Elly Barry ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Troponin T ◽

Lymphoblastic Leukemia ◽

Elevated Serum ◽

Left Ventricular ◽

Serum Samples ◽

Irreversible Damage ◽

Fractional Shortening

Background: Doxorubicin damages heart muscle, placing long-term survivors of childhood cancer at elevated risk of cardiac dysfunction. N-terminal pro-brain natriuretic peptide (NT-proBNP), an independent predictor of mortality and cardiovascular events in other populations, may serve to indicate cardiomyopathy prior to irreversible damage in this population. Methods: To determine the diagnostic value of NT-proBNP in children receiving doxorubicin, the NCI Dana-Farber Cancer Institute ALL Consortium collected serial serum samples and echocardiograms from children with ALL between 1995 and 2000 randomized to receive doxorubicin alone (dox; n = 74; 1203 samples; median age = 6.4 yrs; 30 mg/m 2 /dose for 10 doses) or doxorubicin preceded by the cardioprotectant dexrazoxane (dex/dox; n = 80; 1338 samples; median age = 7.1 yrs; 300 mg/m 2 /dose). Results: Marked NT-proBNP elevation (NT-proBNP ≥ 100 pg/ml if age ≥ 1; proBNP ≥ 150 pg/ml if age > 1) was seen at baseline (treatment day 0; dox alone = 82.5% of patients abnormal; dex/dox = 87.4%; p = 0.527). During treatment, the percentage of patients with abnormal NT-proBNP levels fell to a minimum of 35.8% in the dox only group and 16.4% in the dex/dox group ( p < 0.001) before rising progressively at the end of treatment (treatment day 220; dox only = 70.8%; dex/dox = 5.3%; p < 0.001). After controlling for treatment, a patient with abnormal NT-proBNP six months after the start of doxorubicin had 2.39 times the odds of having myocardial injury as indicated by elevated cardiac troponin T (cTnT ≥0.01 ng/mL; OR = 2.39; 95%CI 1.156 - 4.946; p = 0.019). Further, at any given time and for either treatment, a patient with abnormal NT-proBNP had 2.36 times the odds of having abnormal LV fractional shortening (OR = 2.36; 95%CI 1.026 - 5.449; p = 0.047). Conclusion: Elevated serum NT-proBNP was significantly related to cumulative unprotected doxorubicin dose, left ventricular fractional shortening, and cTnT during doxorubicin therapy. A much higher percentage of patients exhibited levels of NT-proBNP suggestive of cardiomyopathy than showed death of cardiomyocytes as indicated by elevated cTnT levels. This might allow the testing of individualized preventative therapy for cancer patients at high risk for long-term cardiotoxicity.

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