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Preliminary study on behaviour of atrial natriuretic factor in anthracycline-related cardiac toxicity
B Neri1, M De Scalzi, V De Leonardis
1Department of Internal Medicine IV, Oncological Day-Hospital, University of Florence, Italy.
Abstract:
The atrial natriuretic factor (ANF) plays an important role in the pathogenesis of congestive heart failure (CHF), by influencing electrolyte and water balance and by modifying peripheral vascular resistance, thus affecting left ventricular performance. Anthracycline derivatives are glycoside antibiotics, active against a wide spectrum of tumours. It is well known that acute and severe dose-related delayed cardiotoxicity constitutes the major limitation to their optimal use. A total of 26 female patients (mean age 53 years) undergoing monochemotherapy for advanced breast cancer, were studied. 4'-Epidoxorubicin (Epidx) 120 mg/m2 intravenously was administered every three weeks for a total of a mean of 6.6 therapeutic cycles (3 to 10). Left ventricular ejection fraction (LVEF) determined by radionuclide ventriculography and circulating ANF were measured periodically in all patients. Epidx administration was limited at a cumulative dose ranging between 840 and 1200 mg/m2 because of a 25% decrease in LVEF and due to a progressive rising in ANF plasma levels. Furthermore, two patients who presented clinical symptoms of CHF had also significantly increased ANF levels (56 and 49% respectively). The current evidence suggests an important pathophysiological role of ANF in anthracyclinic related CHF. Hopefully measurement of plasma ANF will provide a simple non-invasive method of assessing ventricular dysfunction related to anthracycline cardiac toxicity and might represent an additional objective indicator of the severity of haemodynamic compromise in patients with impaired cardiac function.
Insights
Atrial natriuretic factor (ANF) may indicate cardiotoxicity in breast cancer patients receiving anthracyclines. Rising ANF levels correlate with decreased left ventricular ejection fraction (LVEF), suggesting its role in chemotherapy-induced heart failure.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- Atrial natriuretic factor (ANF) is implicated in congestive heart failure (CHF) pathogenesis.
- Anthracyclines, used in cancer treatment, can cause dose-related cardiotoxicity, limiting their use.
- Assessing this cardiotoxicity is crucial for patient management.
Purpose of the Study:
- To investigate the role of ANF in anthracycline-induced cardiotoxicity.
- To evaluate ANF as a potential non-invasive biomarker for left ventricular dysfunction in patients treated with 4'-Epidoxorubicin (Epidx).
Main Methods:
- Studied 26 female breast cancer patients receiving Epidx monochemotherapy.
- Periodically measured left ventricular ejection fraction (LVEF) using radionuclide ventriculography.
- Monitored circulating ANF plasma levels throughout treatment.
Main Results:
- Epidx treatment was limited by a 25% decrease in LVEF and rising ANF levels.
- Two patients with CHF symptoms showed significantly elevated ANF levels (56% and 49%).
- Progressive increase in ANF correlated with cumulative Epidx dose and reduced LVEF.
Conclusions:
- ANF appears to play a significant pathophysiological role in anthracycline-related CHF.
- Plasma ANF measurement may offer a non-invasive method to assess anthracycline-induced ventricular dysfunction.
- ANF levels could serve as an objective indicator of hemodynamic compromise in patients with cardiac impairment.