Natriuretic peptides in the monitoring of anthracycline induced reduction in left ventricular ejection fraction
Natriuretic peptides in the monitoring of anthracycline induced reduction in left ventricular ejection fraction
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DOI：
10.1016/j.ejheart.2004.03.009
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发表时间：
2005-01-01
影响因子：
18.2
通讯作者：
Kjaer, A
中科院分区：
文献类型：
--
作者：
Daugaard, G;Lassen, U;Kjaer, A
背景：蒽环类药物在癌症治疗中的使用受到这些化合物的心脏毒性的限制，并可能导致心力衰竭。因此，在治疗过程中监测心脏功能是必要的。目的：以放射性核素左心室射血分数(EF)为参照，评价利钠肽(N端心钠素前体(N-ANP)和脑利钠肽(BNP))对监测和预测蒽环类药物心脏毒性的价值。方法和结果：共有107名连续接受化疗的恶性肿瘤患者接受了蒽环类药物的研究。用放射免疫法测定血浆多肽浓度，用放射性核素心动图测定EF。对于降低的EF值，即低于0.50，N-ANP或BNP与EF之间有相当强的相关性。在48例连续测量EF和多肽的患者中，19%的患者的EF显著降低(>；0.10)，最终EF值低于0.50。基线EF不是治疗期间EF变化的预测指标。治疗期间N-ANP或BNP的基线水平或相同变量的变化均不能预测EF的变化。结论：尽管肽浓度与降低的EF值之间存在相关性，但无论是基线值还是连续测量都不能安全地替代接受蒽环类药物治疗的患者的EF值监测。(C)2004年欧洲心脏病学会。爱思唯尔出版公司版权所有。
Background: The use of anthracyclines in treatment of cancer is limited by cardiotoxicity of these compounds and may lead to heart failure. Therefore monitoring of cardiac function is necessary during therapy. Aim: We evaluated the value of natriuretic peptides (N-terminal pro-atrial natriuretic peptide (N-ANP) and brain natriuretic peptide (BNP)) for monitoring and predicting anthracycline induced cardiotoxicity using radionuclide left ventricular ejection fraction (EF) measurements as reference. Methods and results: A total of 107 consecutive patients receiving anthracycline as part of their chemotherapy for malignant disease were studied. Plasma concentrations of the peptides were measured by radioimmunoassay and EF by radionuclide cardiography. For reduced EF values, i.e. below 0.50 a fairly strong correlation was found between N-ANP or BNP and EF. Of 48 patients with serial EF and peptide measurements, 19% showed a significant EF decrease (>0.10) and ended with a final EF value below 0.50. Baseline EF was no predictor of a change in EF during treatment. Neither baseline levels of N-ANP or BNP nor a change in the same variables during therapy were predictive of a change in EF. Conclusions: In spite of correlations between peptide concentrations and reduced EF values neither baseline values nor serial measurements can safely substitute EF monitoring in patients undergoing anthracycline therapy. (C) 2004 European Society of Cardiology. Published by Elsevier B.V All rights reserved.