Introduction: Early prediction of anticancer therapy cardiotoxicity is essential for applying proper preventive and supporting therapeutic strategies.
Objective: To evaluate plasma N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) related to cardiac dysfunction assessed by transthoracic 2D echocardiography (2D-TTE) in patients with cancer and early onset asymptomatic anthracycline-induced cardiomyopathy (AIC).
Methods: Prospective study of 68 patients with cancer treated with anthracyclines, followed up for 6 months. Diagnosis of AIC was set at 6 months by decreasing of left ventricular ejection fraction (LVEF) below 50% or with more than ten units or 20% from baseline. NT-proBNP and 2D-TTE were assessed at enrolment, and thereafter at 3 and 6 months.
Results: Fifteen (22.1%) patients developed AIC at 6 months of anthracycline treatment (group 1), and 53 (77.95%) patients did not evolve with AIC (group 2). At 3 months, in patients from group 1 NT pro-BNP was significantly higher compared to group 2 (121.0 (119.8; 140.8) pg/ml vs 97.7 (75.5; 111.7) pg/ml, P=0.0001, values expressed as median (25th; 75th percentiles)). Left ventricular (LV) diastolic dysfunction was significantly more frequent in group 1 (93.3%) vs group 2 (37.7%), P=0.0002. NT-proBNP at 3 months proved accurate in predicting asymptomatic AIC at 6 months (area under the receiver operating characteristic curve (AUC)=0.845, 95% CI: 0.7350.954, P=0.0001). New-installed diastolic dysfunction at 3 months had a sensitivity of 60%, a specificity of 77% in predicting AIC at 6 months. NT-proBNP assessed at 3 months above a cut-off=118.5 pg/ml was an independent predictor of AIC at 6 months.
Conclusions: Plasma NT-proBNP at 3 months of anthracycline therapy proved to be an early independent predictor of asymptomatic anthracycline-induced cardiomyopathy.