Use of natriuretic peptides for detecting cardiac dysfunction in long-term disease-free breast cancer survivors.

BACKGROUND Plasma natriuretic peptides are increased in patients with cardiac dysfunction. N-terminal (NT-ANP) and B-type (BNP) natriuretic peptides were measured in disease-free breast cancer survivors, during long-term follow-up after epirubicin (360 mg/m2 or 450 mg/m2 cumulatively) and chest irradiation. PATIENTS AND METHODS Plasma samples for natriuretic peptide measurement were repeated after extended follow-up in 54 patients, who had participated in 2 studies evaluating cardiotoxicity. RESULTS From a median follow-up of 2.7 to 6.5 years, median BNP was raised almost three-fold (p<0.001). Symptomatic heart failure was now present in 2 patients. Compared to the epirubicin 360 mg/m2 group, BNP was higher (p=0.006) in the 450 mg/m2 group, with a trend (p=0.054) for higher NT-ANP. CONCLUSION These findings suggest that anticancer therapy initiates an autonomically progressive process that may ultimately lead to symptomatic cardiac dysfunction, years after treatment. BNP measurement may be of value to identify patients requiring intensive cardiac follow-up.