The utility of NT−proBNP and various echocardiographic methods in the determination of doxorubicin induced subclinical late cardiotoxicity

Abstract

Background and aim: Our aims were to investigate the utility of plasma N terminal-pro B-type natriuretic peptide (NT-proBNP) level and find the most beneficial echocardiographic parameters to detect subclinical cardiotoxicity in childhood- cancer survivors treated with doxorubicin.

Methods: The study included 23 patients with a mean age of 17.1 years, who had received doxorubicin therapy with a mean cumulative dose of 241.1 mg/m2 with a median time period of 10.5 years since the last dose of doxorubicin. The control group consisted of 19 healthy volunteers matched for age, sex, and weight.

Results: The serum NT-proBNP levels of the patient group were higher than the control group. The measurements of myocardial performance index (MPI), tissue Doppler mitral septal annulus systolic (S’s) and early diastolic (E’s) velocities, ratio of early mitral flow velocity (E) to E’s (E/E’s), left ventricular diastolic volume (LVDV), tricuspid early diastolic velocity (TE) and percentage of left ventricular posterior wall thickness (%LVPWt) were found to be significantly different from the control group. MPI values were significantly correlated with NT-proBNP levels and cumulative doxorubicin doses.

Conclusions: Elevated MPI values, associated with high NT-pro BNP levels and high cumulative doxorubicin doses, could be a useful indicator of subclinical cardiotoxicity. NT-proBNP could be an effective marker in the long-term follow up of subclinical cardiotoxicity.