Plasma Brain Natriuretic Peptide, Serum Troponin T and Echocardiographic Evaluation in Children Treated with Doxorubicin*.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4583-4583
Author(s):  
Teresa Jackowska ◽  
Robert Wasilewski ◽  
Maria Wasik ◽  
Malgorzata Golabek ◽  
Michal Matysiak
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Plasma Levels ◽  
Troponin T ◽  
Systolic Function ◽  
Clinical Signs ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Healthy Children ◽  
Plasma Brain Natriuretic Peptide

Abstract Background: Doxorubicin (DOX) is one of the most effective agents in treatment of acute lymphoblastic leukaemia (ALL). However, a potential heart damage caused by DOX in patients who have been cured of ALL may lessen the success of their cure. Plasma brain natriuretic peptide levels and cardiac Troponin T are highly sensitive biochemical markers for myocardial damage. Objectives of the study: We aimed to measure N-terminal proBNP (8–29) (Nt-proBNP) and serum Troponin T(cTnT) levels in 125 children (98 with ALL after completion of treatment with DOX and 27 healthy children). Median age at diagnosis was 5.5 years. Methods used: Concentration of plasma N-terminal proBNP was measured in children by enzyme immunoassay (Biomedica). cTnT levels were measured by an electrochemiluminescence immunoassay process (Third generation) on the Elecsys 1010 System (Roche Diagnostic). Echocardiograms were performed by paediatric cardiologists. Using two-dimensional M-mode echocardiography shortening fraction (%SF) and ejection fraction (%EF) were determined as systolic function. Results: The cumulative DOX doses were 240mg/m2. None of the patients had clinical signs or symptoms of cardiotoxicity. All of the patients had normal systolic function parameters. Mean Nt-proBNP plasma levels were normal − 64 fmol/ml (10.3–597.3 fmol/ml) in all examined children. Mean Nt-proBNP both in ALL patients (63.8 fmol/ml) and in healthy (58.4 fmol/ml) were within the normal range. Out of the 98 patients 45 (46%) had slightly elevated Nt-proBNP levels in comparison with healthy subjects. Nt-proBNP plasma levels were not significantly different in boys (55.8 fmol/mL) in comparison with girls (56.3 fmol/mL. In all patients the serum levels of cTnT were below the detection limit (<0.010 ng/ml). Conclusion: Our preliminary results suggest that measurement of Nt-proBNP plasma levels is useful in the detection of subclinical left ventricular dysfunction in children with ALL receiving DOX therapy.

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

2018 ◽  
Vol 9 (5) ◽  
pp. 496-503 ◽  
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.

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

Circulation ◽  
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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