The early findings on 2D transthoracic echocardiography in relation to plasma levels of NT pro-BNP in anthracycline-induced cardiomyopathy

Introduction: Purpose: The evaluation of the diastolic dysfunction of left ventricle (DDLV) and increased plasma levels of N-terminal pro-brain natriuretic peptide (NT pro-BNP) in patients with early anthracycline-induced cardiomyopathy (eAIC) occurring before the reduction at the diagnostic value of the left ventricle ejection fraction (LVEF). Method: 68 patients with cancer treated with anthracyclines (AT) were followed 6 months for the occurrence of eAIC, diagnosed when LVEF decrease < 50% or by 10% compared to baseline (ACC/AHA/ASE Committee 2003). The 2D TTE and plasma levels of NT pro-BNP were determined at baseline, 3 and 6 months after AT. NT pro-BNP plasma levels >125 pg/ml were considered elevated (2012 ESC Heart Failure Guideline). Were evaluated LVEDV/m2, LVESV/m2, LVEF%, DDLV [E/A, E/e’ and E/Vp ratio, EDT, left atrium volume/m2 (LAV/m2)]. DDLV and plasma levels of NT pro-BNP at patients diagnosed at 6 month with pAIC were compared with those of patients evolved without pAIC. Statistics used GraphPad InStat 3 program. Statistical significance was considered for p < 0,05. Results: At 6 months 15 patients (pts) (22.05%) were diagnosed with eAIC (Gr1) and 53 (77,95%) evolved without eAIC (Gr2). At baseline there were no significant differences of 2D ETT parameters and NT proBNP plasma values between the two groups. After 3 months, the pts in Gr 1 showed on 2D TTE signifi cantly more often mild and moderate DDLV [14 pts (93.3%) vs. 7 pts (37.7%), p = 0.0002] in association with significantly increased LAV/m2 (49.4 ± 18.8 ml/m2 vs. 31.4 ± 9.7 ml/m2, p = 0.0002) and LVESV/m2 (32.3 ± 4.3 ml/m2 vs. 27.8 ± 4.6 ml/m2, p = 0.002), without significantly increasing of LVEDV/m2 (70.7 ± 7.7 ml/m2 vs. 67.3 ± 10.2 ml/m2, p = 0.1805). After 3 months, the plasma levels of NT pro-BNP was significantly increased in Gr1 vs Gr 2 (126.5 ±20.8 pg/ml vs. 94.5 ± 25 pg/ ml, p  0.0001). Conclusions: Decreasing of the left ventricle ejection fraction at the diagnostic level for early anthracyclineinduced cardiomyopathy is preceded by the occurrence of mild and moderate diastolic dysfunction of left ventricle, left atrium dilatation and increased plasma levels of NT pro-BNP.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)