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Plasma B-type natriuretic peptide (BNP): a useful marker for anthracycline-induced cardiotoxicity in Korean children with cancer

Korean Journal of Pediatrics 2007;50(8):774-780.
Published online August 15, 2007.
Plasma B-type natriuretic peptide (BNP): a useful marker for anthracycline-induced cardiotoxicity in Korean children with cancer
Hyun Dong Lee, Jae Min Lee, Yong Jik Lee, Young Hwan Lee, Jeong Ok Hah
Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
한국인 소아암 환자에서 anthracycline 유발 심독성에 대한 지표로서 BNP 혈장농도의 유용성
이현동, 이재민, 이용직, 이영환, 하정옥
영남대학교 의과대학 소아과학교실
Correspondence: 
Jeong Ok Hah, Email: johah@med.yu.ac.kr
Abstract
Purpose
: The anthracyclines (AC) are widely used chemotherapeutic agents for pediatric cancers. However, the therapeutic use of these agents is limited by their cardiotoxicity. The aim of the present study was to investigate the usefulness of plasma B-type natriuretic peptide (BNP) levels as a marker for AC-induced cardiotoxicity compared to echocardiography in Korean children with cancer.
Methods
: Fifty-five pediatric cancer patients who had received chemotherapy including AC were enrolled. The cumulative AC doses, clinical symptoms, and two echocardiography parameters, left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF), were studied and compared with plasma BNP levels.
Results
: In 55 patients, plasma BNP levels were measured 115 times and echocardiographies were performed 64 times. The median cumulative dose of AC was 325 mg/m2 (range 120-600; mean 345) and the median plasma BNP level was 10 pg/mL (range 5-950; mean 31). The cumulative AC doses correlated significantly with the plasma BNP levels (P=0.002). The plasma BNP levels correlated significantly with LVFS (P=0.018) and LVEF (P=0.025). Dilated cardiomyopathies were identified in three patients. LVFS and LVEF decreased and plasma BNP levels increased in a patient with acute dilated cardiomyopathy and in that with symptomatic chronic dilated cardiomyopathy. However, LVFS, LVEF and plasma BNP levels were normal in a patient with asymptomatic chronic dilated cardiomyopathy.
Conclusion
: The results of this study demonstrated that plasma BNP levels could be used as a marker for AC-induced cardiotoxicity; they showed good correlation with echocardiography findings in pediatric cancer patients. Plasma BNP levels may be used for the detection and management of AC-induced cardiotoxicity in Korean children with cancer.
Key Words: Anthracycline, Cardiotoxic, B-type natriuretic peptide


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