Early and late elevation of plasma atrial and brain natriuretic peptides in patients after bone marrow transplantation

Clinical usefulness of bone marrow transplantation (BMT) remains limited by myocardial damage during the post-transplantation period. Measurements of plasma atrial and brain natriuretic peptides (ANP, BNP) during the acute po st-transplantation period could serve to monitor cardiac complications sinc e these peptides are known to increase in heart failure depending on its se verity. We prospectively analyzed ANP and BNP levels from 14 days before to 100 days after BMT in 46 consecutive patients undergoing allogeneic (n = 4 2) and autologous (n = 4) transplantation. Cardiac performance was assessed by echocardiography and radionuclide ventriculography. BNP and ANP levels of the patients on admission (baseline: day-14) were 16.3 +/- 13.3 pg/ml an d 14.4 +/- 8.8 pg/ml, respectively. There were two different types of chang es in the BNP and ANP levels. The 21 patients in group I showed dual peaks of elevation on day 1 (BNP = 164.4 +/- 136.0 pg/ml, P < 0.01; ANP = 44.5 +/ - 35.4 pg/ml, NS) and day 14 (BNP = 233.9 +/- 106.2 pg/ml, P < 0.01; ANP = 142.7 +/- 154.6 pg/ml, P < 0.05), whereas the remaining 25 patients in grou p II had a single peak on day 1 (BNP = 124.5 +/- 124.9 pg/ml, P < 0.05; ANP = 45.2 42.4 pg/ml, NS). The left ventricular ejection fraction on day 63 w as unchanged in both groups of patients from the baselines. The time to pea k filling rate, a parameter of diastolic function in the radionuclide ventr iculography, was significantly prolonged in group I patients (by 30 +/- 53% ), whereas unaffected in group II patients. These results suggest that plas ma BNP monitoring for 2 weeks after BMT may be useful for early detection o f patients at high risk for cardiac dysfunction in the post-transplantation period.