BNP cannot replace gated equilibrium radionuclide ventriculography in monitoring of anthracycline-induced cardiotoxity.

BACKGROUND: Cardiotoxity is a side-effect of cancer treatment with anthracycline that is currently monitored by measuring the left ventricular ejection fraction (LVEF) by gated equilibrium radionuclide ventriculography (RNV). We hypothesized that BNP measurements could replace, at least in part, the RNV examinations. Therefore, we studied whether BNP could be used, alone or in combination with RNV, in the monitoring of anthracycline-induced cardiotoxity. METHODS: A total of 333 patients undergoing anthracycline treatment had LVEF and BNP concentration measured. Of these, 73 had more than one determination. In the 333 patients we compared the BNP concentration to LVEF, and further, for the 73 patient with more than one examination, we compared the changes in LVEF and BNP. We evaluated different BNP cut-off values for detection of LVEF below 0.50, 0.45 and 0.40, respectively. RESULTS: Using LVEF below 0.50 and a BNP cut-off value of 100 pg ml(-1) it was possible to save 90% of the RNV determinations with the cost of overlooking 68% of the patients with reduced LVEF. Using LVEF below 0.45 and a BNP cut-off value of 30 pg ml(-1) it was possible to save 59% of the RNV determination, with the cost of overlooking 15% of the patients with reduced LVEF. CONCLUSION: BNP cannot safely be used as an alternative to RNV determination of LVEF in patient undergoing anthracycline treatment if the standard limit of an LVEF of 0.50 was used. However, if only lower LVEF were to be detected BNP could be used to save RNV determinations.

Independent effects of both right and left ventricular function on plasma brain natriuretic peptide.

BACKGROUND: Brain natriuretic peptide (BNP) is increased in heart failure; however, the relative contribution of the right and left ventricles is largely unknown. AIM: To investigate if right ventricular function has an independent influence on plasma BNP concentration. METHODS: Right (RVEF), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume index (LVEDVI) were determined in 105 consecutive patients by first-pass radionuclide ventriculography (FP-RNV) and multiple ECG-gated equilibrium radionuclide ventriculography (ERNV), respectively. BNP was analyzed by immunoassay. RESULTS: Mean LVEF was 0.51 (range 0.10-0.83) with 36% having a reduced LVEF (<0.50). Mean RVEF was 0.50 (range 0.26-0.78) with 43% having a reduced RVEF (<0.50). The mean LVEDVI was 92 ml/m2 with 22% above the upper normal limit (117 ml/m2). Mean BNP was 239 pg/ml range (0.63-2523). In univariate linear regression analysis LVEF, LVEDVI and RVEF all correlated significantly with log BNP (p<0.0001). In a multivariate analysis only RVEF and LVEF remained significant. The parameter estimates of the final adjusted model indicated that RVEF and LVEF influence on log BNP were of the same magnitude. CONCLUSION: BNP, which is a strong prognostic marker in heart failure, independently depends on both left and right ventricular systolic function. This might, at least in part, explain why BNP holds stronger prognostic value than LVEF alone.