B-type natriuretic peptide as a marker for cardiac dysfunction in anthracycline-treated children

Sanjeev Aggarwal, Michael D. Pettersen, Kanta Bhambhani, Joellyn Gurczynski, Ronald Thomas, Thomas L'Ecuyer

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63 Scopus citations


Background. Anthracyclines (AC) are useful antineoplastic agents, whose utility is limited by progressive cardiotoxicity. Our purpose was to evaluate plasma B-type natriuretic peptide (BNP), as a screening test for detecting late cardiac dysfunction in AC-treated children and to determine the prevalence of late cardiac dysfunction at low cumulative AC doses. Materials and Methods. This was a prospective study in which patients who had completed AC therapy at least 1 year earlier, underwent a detailed echocardiogram and a simultaneous BNP level. Cardiac dysfunction was defined as any one of the following: shortening fraction (FS) <29%, rate corrected velocity of circumferential fiber shortening (VCFc) <0.9 c·sec-1, end systolic wall stress (ESWS) >60 g·cm-2, abnormal VCFc: ESWS ratio or decreased mitral inflow velocity (E/A) ratios, compared to age-specific norms. Results. The cohort (n = 63) included 37 males with a median age of 13.1 years (range, 6.5-26.5 years). Cardiac dysfunction was found in 26 (41%) patients and in 40% of patients who received cumulative doses <150 mg·m-2. ESWS was the most common abnormality. Mean BNP levels in the subset with abnormal function were significantly higher than the normal group (23.4 ± 25.3 vs. 14.2 ± 8.9 pg·ml-1, P = 0.02). Conclusions. Plasma BNP was significantly elevated in AC-treated patients with late cardiac dysfunction, although there was considerable overlap of levels between groups with and without cardiac dysfunction. BNP may need further evaluation as a serial index of cardiac function in this population. Cardiac dysfunction was observed in a significant proportion of patients, even at low cumulative AC doses.

Original languageEnglish
Pages (from-to)812-816
Number of pages5
JournalPediatric Blood and Cancer
Issue number6
StatePublished - Nov 2007


  • Anthracyclines-induced cardiotoxicity
  • BNP


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