SERUM N-TERMINAL ATRIAL-NATRIURETIC-PEPTIDE (NT-ANP) IN THE CARDIAC FOLLOW-UP IN CHILDREN WITH CANCER

Background. We studied serum N-terminal atrial natriuretic peptide (NT -ANP) in children during and after chemotherapy for cancer to determin e its applicability in detecting cardiac dysfunction. Forty-th ree pat ients were receiving chemotherapy for malignancy. Forty-eight patients were off chemotherapy and survived between 0.9 and 13 (median 5) year s after the diagnosis, receiving cumulative anthracycline doses betwee n 0 and 600 (median 225) mg/m(2). Procedure and Results. Cardiac evalu ation of the patients included measurement of serum NT-ANP, recording of ECC, and assessment of systolic and diastolic function of the heart by echocardiography. During chemotherapy, serum NT-ANP levels were hi gher than in controls but varied markedly in the same individuals. Ser um NT-ANP levels showed no consistent increase in the weeks following anthracycline administration. In late follow-up, serum NT-ANP levels w ere higher than in age-matched controls (median (range), 0.22 (0.06-0. 47) vs. 0.14 (0.06-0.27) nmol/l, respectively, P<.001). The subgroup o f patients with bone marrow transplantation and/or cardiac irradiation had the highest NT-ANP concentrations (0.30 (0.20-0.45) nmol/l). Conc lusions, Thus, serum NT,ANP measurements seemed to represent a useful contribution in the long-term cardiac follow-up of children after canc er. This blood test can readily be included to laboratory follow-up, i s reasonably inexpensive and may decrease the need for more laborious tests of cardiac function. When there is ongoing chemotherapy, NT-ANP levels are influenced by a variety of factors that invalidate its rout ine use during this period. (C) 1998 Wiley-Liss, Inc.