Value of Echocardiography and Serum B-Type Natriuretic Peptide (BNP) Level for Predicting Heart Failure after Chemotherapy
Background:Serum B-type natriuretic peptide (BNP) and echocardiographic findings are among the invaluable tools to predict heart failure in cancer patients receiving chemotherapy. The aim of this study was to measure the serum BNP level and assess the echocardiographic findings of patients with malignancy treated by chemotherapy so as to find out any significant changes in the values of the mentioned indices.
Methods :This cross-sectional study was performed on 40 consecutive cancer patients who received various chemotherapeutic regimens. Serum BNP levels were measured as well as echocardiographic evaluation by 2-dimensional and Doppler echocardiography (using a Vivid 3 instrument) at baseline (before administering chemotherapy) and at 3 and 6 months after chemotherapy. Echocardiographic indices included left ventricular ejection fraction (LVEF), fractional shortening, tricuspid annular plane systolic excursion (TAPSE), and left ventricular end-diastolic diameter (LVEDD).
Results:Eleven (27.5%) patients developed heart failure (ie, LVEF < 55%) at 6 months' follow-up. The mean LVEF at baseline was 59.00% (± 3.62), which decreased to 55.58% (± 5.80) at 6 months (P < 0.001). The mean LVEDD at baseline was 53.70 (± 3.74), which significantly increased to 56.60 (± 5.30) 6 months after chemotherapy. The mean (SD) serum BNP level was 51.08 (± 22.51), which significantly increased to 95.80 (± 63.56) after 6 months (P < 0.001). The best cutoff point of BNP for discriminating heart failure from normal heart condition was 136.5 pg/mL, yielding sensitivity of 81.8% and specificity of 96.6%.
Conclusions:Each of the parameters of LVEF, fractional shortening, TAPSE, LVEDD, and even serum level of BNP underwent deteriorating changes at 3 months after chemotherapy, indicating the early occurrence of heart failure in these patients. However, following these changes, compensatory systems can be activated to regulate these cardiac parameters.