N-Terminal Pro Brain Natriuretic Peptide and Cardiac Function in Doxorubicin Administered Pediatric Patients
Wasana Hongkan MD*, Jarupim Soongswang MD*, Gavivann Veerakul MD**, Kleebsabai Sanpakit MD**, Kesaree Punlee BSc***, Wandee Rochanasiri BSc***, Suthipol Udompunturak MSc****
Affiliation : * Division of Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Research Promotion Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Assess the use of N terminal pro brain natriuretic peptide (NT-pro BNP) to early diagnose ventricular
dysfunction in doxorubicin-administered children.
Material and Method: Fifty-five cancer patients who received accumulative dose of doxorubicin <300 mg/m2
(group 1), 49 cases with accumulative dose > 300 mg/m2 (group 2) and 52 cases as a control group (group 3)
were included in the study. Electrocardiogram, chest roentgenogram, echocardiogram, and serum NT-pro
BNP were studied.
Results : At age 1-10 years, there were significantly higher NT-pro BNP in group 2 than group1 (384 + 291 vs.
92.2 + 89 pg/ml; p = 0.001), and than group 3 (79 + 92 pg/ml; p = 0.001). Patients with NT-pro BNP level >1
SD of the control group were more likely to have abnormal > 2 echocardiographic parameters of left ventricular
diastolic dysfunction than patients with NT-pro BNP < 1 SD (OR = 3.8, 95% CI 1.18-12.5). Patients in group
2 were more likely to have abnormal > 2 parameters of left ventricular diastolic dysfunction than patients in
group 1 (OR = 2.8, 95% CI 1.07-7.7) and more likely to have NT-pro BNP >1 SD than group 1 (OR = 8, 95%
CI 1.96-38.4). There were association of NT-pro BNP >1 SD, accumulative dose of doxorubicin > 300 mg/m2,
and early left ventricular diastolic dysfunction by echocardiogram.
Conclusion : Serum NT-pro BNP >1 SD has a high probability to diagnose early doxorubicin-induced
cardiomyopathy in patient 1-10 years old.
Keywords : Serum NT-pro BNP, Doxorubicin-induced cardiomyopathy, Diastolic dysfunction
