open access

Vol 48, No 2 (2014)
Original research articles
Submitted: 2013-02-20
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The N-terminal pro-brain natriuretic peptide as a marker of mitoxantrone-induced cardiotoxicity in multiple sclerosis patients

Aleksandra Podlecka-Piętowska, Janusz Kochanowski, Beata Zakrzewska-Pniewska, Grzegorz Opolski, Hubert Kwieciński, Anna Maria Kamińska
DOI: 10.1016/j.pjnns.2013.12.005
·
Neurol Neurochir Pol 2014;48(2):111-115.

open access

Vol 48, No 2 (2014)
Original research articles
Submitted: 2013-02-20

Abstract

Background and purpose

Mitoxantrone (MTX) has been shown to reduce progression of disability and number of clinical exacerbations in patients with progressive multiple sclerosis (MS). Prolonged administration of MTX, however, is limited by the risk of cardiotoxicity. Cardiac monitoring in MTX-treated patients includes usually measurement of left ventricular ejection fraction (LVEF) by means of echocardiography. The N-terminal pro-brain natriuretic peptide (NT-proBNP) represents a novel diagnostic tool in the assessment of heart failure. This study was aimed to evaluate the usefulness of NT-proBNP for early detection of MTX-induced cardiotoxicity in MS patients.

Materials and methods

We measured the NT-proBNP plasma levels in 45 MS patients who completed 24-month MTX therapy and in 37 MS patients of control group.

Results

The median NT-proBNP plasma value was 15.12pg/mL. In 12 MTX-treated patients (27%), NT-proBNP plasma values were elevated, though this subgroup of patients neither clinical showed evidence of myocardial damage nor had the LVEF value <50%. In five patients with normal NT-proBNP, we observed LVEF decline >10%. We did not observe correlations between the NT-proBNP levels and patient age, MS duration, relapses index, Extended Disability Status Scale (EDSS), MTX single dose and the total cumulative dose of MTX. In 8 patients (22%) from control group, NT-proBNP plasma levels were also elevated.

Conclusions

The results of our study confirm that MTX therapy is safe for carefully selected and closely monitored MS patients. We believe that serial evaluation of NT-proBNP levels (before, during and after MTX therapy) can identify MS patients at high risk for MTX-induced cardiotoxicity.

Abstract

Background and purpose

Mitoxantrone (MTX) has been shown to reduce progression of disability and number of clinical exacerbations in patients with progressive multiple sclerosis (MS). Prolonged administration of MTX, however, is limited by the risk of cardiotoxicity. Cardiac monitoring in MTX-treated patients includes usually measurement of left ventricular ejection fraction (LVEF) by means of echocardiography. The N-terminal pro-brain natriuretic peptide (NT-proBNP) represents a novel diagnostic tool in the assessment of heart failure. This study was aimed to evaluate the usefulness of NT-proBNP for early detection of MTX-induced cardiotoxicity in MS patients.

Materials and methods

We measured the NT-proBNP plasma levels in 45 MS patients who completed 24-month MTX therapy and in 37 MS patients of control group.

Results

The median NT-proBNP plasma value was 15.12pg/mL. In 12 MTX-treated patients (27%), NT-proBNP plasma values were elevated, though this subgroup of patients neither clinical showed evidence of myocardial damage nor had the LVEF value <50%. In five patients with normal NT-proBNP, we observed LVEF decline >10%. We did not observe correlations between the NT-proBNP levels and patient age, MS duration, relapses index, Extended Disability Status Scale (EDSS), MTX single dose and the total cumulative dose of MTX. In 8 patients (22%) from control group, NT-proBNP plasma levels were also elevated.

Conclusions

The results of our study confirm that MTX therapy is safe for carefully selected and closely monitored MS patients. We believe that serial evaluation of NT-proBNP levels (before, during and after MTX therapy) can identify MS patients at high risk for MTX-induced cardiotoxicity.

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Keywords

N-terminal pro-brain natriuretic peptide, Mitoxantrone, Cardiotoxicity, Multiple sclerosis

About this article
Title

The N-terminal pro-brain natriuretic peptide as a marker of mitoxantrone-induced cardiotoxicity in multiple sclerosis patients

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 48, No 2 (2014)

Pages

111-115

DOI

10.1016/j.pjnns.2013.12.005

Bibliographic record

Neurol Neurochir Pol 2014;48(2):111-115.

Keywords

N-terminal pro-brain natriuretic peptide
Mitoxantrone
Cardiotoxicity
Multiple sclerosis

Authors

Aleksandra Podlecka-Piętowska
Janusz Kochanowski
Beata Zakrzewska-Pniewska
Grzegorz Opolski
Hubert Kwieciński
Anna Maria Kamińska

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