Journal Article

Cardiovascular biomarkers in patients with cancer and their association with all-cause mortality

Hülsmann, Martin, Hejna, Michael, Raderer, Markus, Strunk, Guido, Pavo, Noemi, Adlbrecht, Christopher, Parschalk, Bernhard, Gisslinger, Heinz, Scheithauer, Werner, Pirker, Robert, Goliasch, Georg, Köstler, Wolfgang, Steger, Günther G, Auerbach, Leo, Pacher, Richard, Kornek, Gabriela, Zöchbauer-Müller, Sabine, Marosi, Christine, Zielinski, Christoph, Schneider, Sven, Neuhold, Stephanie, Drach, Johannes

2015

Overview

ObjectivePatients with cancer may display elevated levels of B-type natriuretic peptide (BNP) and high-sensitive troponin T (hsTnT) without clinical manifestation of cardiac disease. This study aimed to evaluate circulating cardiovascular hormones and hsTnT and their association with mortality in cancer.MethodsWe prospectively enrolled 555 consecutive patients with a primary diagnosis of cancer and without prior cardiotoxic anticancer therapy. N-terminal pro BNP (NT-proBNP), mid-regional pro-atrial natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), copeptin, hsTnT, proinflammatory markers interleukin 6 (IL-6) and C reactive protein (CRP), and cytokines serum amyloid A (SAA), haptoglobin and fibronectin were measured. All-cause mortality was defined as primary endpoint.ResultsDuring a median follow-up of 25 (IQR 16–31) months, 186 (34%) patients died. All cardiovascular hormones and hsTnT levels rose with tumour stage progression. All markers were significant predictors of mortality with HRs per IQR of 1.54 (95% CI 1.24 to 1.90, p<0.001) for NT-proBNP, 1.40 (95% CI 1.10 to 1.79, p<0.01) for MR-proANP, 1.31 (95% CI 1.19 to 1.44, p<0.001) for MR-proADM, 1.21 (95% CI 1.14 to 1.30, p<0.001) for CT-proET-1, 1.22 (95% CI 1.04 to 1.42, p=0.014) for copeptin and 1.21 (95% CI 1.13 to 1.32, p<0.001) for hsTnT, independent of age, gender, tumour entity and stage, and presence of cardiac comorbidities. NT-proBNP, MR-proANP, MR-proADM and hsTnT displayed a significant correlation with IL-6 and CRP.ConclusionsCirculating levels of cardiovascular peptides like NT-proBNP, MR-proANP, MR-proADM, CT-pro-ET-1 and hsTnT were elevated in an unselected population of patients with cancer prior to induction of any cardiotoxic anticancer therapy. The aforementioned markers and copeptin were strongly related to all-cause mortality, suggesting the presence of subclinical functional and morphological myocardial damage directly linked to disease progression.

• Publisher: BMJ Publishing Group LTD
• Subject: Adrenomedullin - blood / Aged / Asymptomatic Diseases / Atrial Natriuretic Factor - blood / Austria - epidemiology / Biomarkers - blood / C-Reactive Protein - analysis / Cancer / Cardiovascular disease / Cardiovascular Diseases - etiology / Cardiovascular Diseases - metabolism / Cardiovascular Diseases - physiopathology / Clinical medicine / Endothelin-1 - blood / Female / Glycopeptides - blood / Heart attacks / Heart failure / Humans / Kaplan-Meier Estimate / Male / Medical prognosis / Middle Aged / Morphology / Mortality / Natriuretic Peptide, Brain - blood / Neoplasm Staging / Neoplasms - blood / Neoplasms - complications / Neoplasms - mortality / Neoplasms - pathology / Peptide Fragments - blood / Peptides / Prospective Studies / Protein Precursors - blood / Rodents / Studies / Troponin T - blood / Tumors / Variables