Predictive value of N-terminal pro-brain natriuretic peptide in patients after treatment of multiple myeloma

B.B. Samura


Background. Multiple myeloma is one of the most common lymphoid malignancies. The introduction of immunomodulatory agents and proteasome inhibitors has improved the survival of patients with this disease, including elderly subjects. However, there is a subgroup of frail subjects, most of whom are elderly, who are susceptible to side effects of chemotherapy and are often unable to tolerate full dose treatment. Little is known about the long-term cardiovascular status of intensively treated survivors. Brain natriuretic peptide and the N-amino terminal fragment of the pro-hormone brain natriuretic peptide (NT-proBNP) are released predominantly from the ventricular myocardium in response to increased ventricular wall stress. They are measures of ventricular dysfunction and have a predictive utility for cardiovascular events and mortality, but because they are cleared by the kidneys, this influences the glomerular filtration rate. Moreover, the prognostic value of NT-proBNP has been shown to be independent of traditional cardiovascular risk factors, prevalent cardiovascular disease, left ventricular dysfunction, and renal function. We purposed to evaluate the prognostic value of circulating NT-proBNP in patients after treatment of multiple myeloma. Materials and methods. Eighty nine subjects after treatment of multiple myeloma were enrolled in the study. Diagnosis and staging of multiple myeloma were defined by current clinical practice guidelines. To achieve the remission, chemotherapy with bortezomib, thalidomide, dexamethasone, cyclophosphamide was used according to the contemporary clinical guidelines. All subjects were at full or partial remission stage at baseline. Observation period was up to 12 months. Blood samples for biomarkers measurements were collected. ELISA method was used for measurements of circulating level of NT-proBNP. Echocardiography in B-mode was performed following the recommendations of American Society of Echocardiography on MyLab 50 scanner (Italy) using a transducer with a frequency of 2.5–3.5 MHz. Results. During observation period, the progression of multiple myeloma was proved in 23 patients, 4 persons were excluded due to poor follow-up. Ninety two cumulative clinical events occurred in 36 patients (40.5 %) within the follow-up, with their distribution being as follows: 8 cardiovascular deaths, 46 cardiac arrhythmias, 8 cardiac ischemic events, 2 strokes, 8 chronic heart failures and 22 hospital admissions for cardiovascular causes. Medians of circulating levels of NT-proBNP in free-events subject cohort and subjects cohort with cardiovascular events were 5.68 pg/ml (95% confidence interval (CI) = 2.74–11.51 pg/ml) and 23.87 pg/ml (95% CI = 8.22–31.84 pg/ml) (р = 0.06). In multivariate logistic regression, circulating NT-proBNP independently predicted cumulative cardiovascular events (odds ratio = 1.06; 95% CI = 1.03–1.17; р < 0.01) within 12 months of observation period. Conclusions. Among patients after treatment of multiple myeloma, increased circulating NT-proBNP may associate with increased cumulative cardiovascular events during 12 months.


NT-proBNP; cardiovascular events; multiple myeloma; prognosis


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