ELEVATED B-TYPE NATRIURETIC PEPTIDE LEVELS AFTER ANTHRACYCLINE ADMINISTRATION

Background Cardiotoxicity leading to congestive heart failure is a com plication of the anthracyclines. Biochemical methods to diagnose and m onitor cardiac function after anthracycline administration would be mo st useful. We examined the diagnostic role of B- type natriuretic pept ide (BNP), a potent biochemical marker of left ventricular dysfunction , in patients administered anthracyclines. Methods Twenty-seven consec utive patients receiving anthracyclines were investigated by serial me asurements of BNP levels and other cardiac neurohormones [A-type natri uretic peptide, renin, aldosterone, angiotensin II, norepinephrine, an d epinephrine) and myocardial markers (creatine kinase-MB and myosin l ight chain). Echocardiography was done to assess systolic (ejection fr action) and diastolic (mitral inflow A/E ratio) functions. Results of the examined cardiac biochemical markers, BNP levels alone showed mark ed elevations to abnormal levels after anthracycline administration. M ost patients showed transient increases (peak at 3 to 7 days). Patient s with persistent elevations showed a poor prognosis. A/E ratio also c orrelated with increases in BNP levels in selected patients, which may suggest that raised BNP levels are reflective of induced diastolic dy sfunction. Conclusions our studies suggest the possible use of BNP lev els fa assess the cardiac state after anthracycline administration. BN P levels most likely reflect cardiac tolerance to the cardiotoxic agen t. Serial BNP profiles also suggest persistent elevations to be associ ated with potentially decompensatory states in contrast to tolerable t ransient increases. Diagnosis of degree of cardiac tolerance by respon se to drug administration may be analogous to use of stress testing (e xercise) to help define underlying left ventricular dysfunction.