Natriuretic peptides may be suitable for screening long-term heart failure risk in breast cancer survivors after cardiotoxic chemotherapy

Abstract Background Breast cancer survivors are often exposed to potentially cardiotoxic cancer therapies including anthracyclines, trastuzumab and chest radiation. The long-term risk of heart failure (HF) in breast cancer survivors is variable and existing guidelines regarding HF screening are based upon limited evidence. Objectives To investigate the prevalence of subclinical HF (Stage B/SBHF), abnormal Global Longitudinal Strain (GLS) and elevated natriuretic peptide (NT-proBNP) levels in breast cancer survivors at least 5 years after potentially-cardiotoxic chemotherapy (CC). Methods Clinical review, biochemistry and echocardiography were prospectively obtained to detect SBHF (LV hypertrophy, abnormal GLS, diastolic dysfunction or elevated NT-proBNP levels) in 321 adult breast cancer survivors ≥5 years post-CC. Participants were matched by age and sex with a group of 980 similarly-investigated non-cancer controls with ≥1 HF risk factor, resulting in a group of 321 non-cancer controls. Participants were excluded if they were symptomatic, had a prior history of HF or moderate/severe valvular disease. Results Elevated AF/age-adjusted NT-proBNP levels were notably higher in breast cancer survivors with CC compared to controls (6.2% vs 0.9%, p=0.011). However, breast cancer survivors after CC had no significant difference in prevalence of SBHF compared to controls (21.2% vs 26.2%, p=0.164) or reduced GLS (13.4% vs 12.7%, p=0.688). Similarly, logistic regression demonstrated that breast cancer after CC was independently associated with elevated NT-pro BNP (OR 3.78 95% CI 1.57-9.46. Breast cancer after CC was not associated with SBHF or reduced GLS even after adjustment for age, sex, diabetes and hypertension. Conclusion There are significant elevations of NT-proBNP levels in breast cancer survivors after CC. Breast cancer survivorship was not associated with SBHF or reduced GLS after propensity matching or regression modelling. Universal HF screening in breast cancer survivors post CC is unlikely to be effective. The use of NT-proBNP may be a useful step to select patients for HF surveillance.