PT  - JOURNAL ARTICLE
AU  - Noemi Pavo
AU  - Markus Raderer
AU  - Martin Hülsmann
AU  - Stephanie Neuhold
AU  - Christopher Adlbrecht
AU  - Guido Strunk
AU  - Georg Goliasch
AU  - Heinz Gisslinger
AU  - Günther G Steger
AU  - Michael Hejna
AU  - Wolfgang Köstler
AU  - Sabine Zöchbauer-Müller
AU  - Christine Marosi
AU  - Gabriela Kornek
AU  - Leo Auerbach
AU  - Sven Schneider
AU  - Bernhard Parschalk
AU  - Werner Scheithauer
AU  - Robert Pirker
AU  - Johannes Drach
AU  - Christoph Zielinski
AU  - Richard Pacher
TI  - Cardiovascular biomarkers in patients with cancer and their association with all-cause mortality
AID  - 10.1136/heartjnl-2015-307848
DP  - 2015 Dec 01
TA  - Heart
PG  - 1874--1880
VI  - 101
IP  - 23
4099  - http://heart.bmj.com/content/101/23/1874.short
4100  - http://heart.bmj.com/content/101/23/1874.full
SO  - Heart2015 Dec 01; 101
AB  - Objective Patients 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.Methods We 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.Results During 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.Conclusions Circulating 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.