natriuretic-peptide--brain and Lung-Neoplasms

Postoperative atrial fibrillation (POAF), the most frequent arrhythmia after pulmonary resection, is a cause of both morbidity and mortality. Being able to predict the risk of POAF before surgery would help us evaluate the surgical risk and plan prophylaxis. We investigated the reported preoperative risk factors associated with the incidence of POAF and found that the recommended predictive factors were quite variable. Therefore, we evaluated the previously reported preoperative risk factors for POAF using our institutional data. We discuss our findings in this short review. Male gender, resected lung volume, brain natriuretic peptide (BNP), and left ventricular early transmitral velocity/mitral annular early diastolic velocity (E/e') calculated by echocardiography were suggested as independent predictors for POAF, but the predictive values of each individual parameter were not high. The lack of definitive predictors for POAF warrants further investigations by gathering the reported knowledge, to establish an effective preoperative examination strategy.

Topics: Aged; Atrial Fibrillation; Blood Flow Velocity; Female; Heart Ventricles; Humans; Incidence; Lung Neoplasms; Male; Mitral Valve; Natriuretic Peptide, Brain; Pneumonectomy; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Risk Factors; Sex Factors

A best evidence topic was written according to a structured protocol. The question addressed was whether plasma brain natriuretic peptide (BNP) levels could effectively predict the occurrence of postoperative atrial fibrillation (AF) in patients undergoing non-cardiac thoracic surgery. A total of 14 papers were identified using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. All studies were prospective observational, and all reported a significant association between BNP and N-terminal (NT)-proBNP plasma levels measured in the immediate preoperative period and the incidence of postoperative AF in patients undergoing either anatomical lung resections or oesophagectomy. One study reported a cut-off value of 30 pg/ml above which significantly more patients suffered from postoperative AF (P < 0.0001), while another one reported that this value could predict postoperative AF with a sensitivity of 77% and a specificity of 93%. Another study reported that patients with NT-proBNP levels of 113 pg/ml or above had an 8-fold increased risk of developing postoperative AF. These findings support that BNP or NT-proBNP levels, especially when determined during the preoperative period, if increased, are able to identify patients at risk for the development of postoperative AF after anatomical major lung resection or oesophagectomy. The same does not seem to be true for lesser lung resections. These high-risk patients might have a particular benefit from the administration of prophylactic antiarrhythmic therapy.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Biomarkers; Carcinoma, Squamous Cell; Evidence-Based Medicine; Humans; Lung Neoplasms; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonectomy; Postoperative Complications; Predictive Value of Tests; Preoperative Care; Prognosis; Risk Assessment; ROC Curve; Treatment Outcome

Chronic obstructive pulmonary disease (COPD) can no longer be considered as a disease affecting only the lungs. Increasing evidence supports the presence of a systemic inflammatory component which is thought to provide the link between COPD and the co-morbidities commonly associated with this disease. These include cardiovascular disorders, skeletal muscle dysfunction, diabetes, and osteoporosis. The majority of current therapies for COPD have been developed to improve airway obstruction or to target airway inflammation, leaving an unmet medical need with respect to the systemic inflammatory component of COPD and its extra-pulmonary manifestations. This review describes systemic biomarkers in COPD and their relationship with both the local lung and systemic manifestations of the disease. A summary is provided of the most promising biomarkers that have been investigated in COPD and its co-morbidities. Such biomarkers may be used to assess and manage the systemic effects of COPD, and may guide future development of novel therapeutic interventions to provide a more holistic approach to treating this multi-faceted disease.

Topics: Adiponectin; Aging; Airway Remodeling; Biomarkers; C-Reactive Protein; Cachexia; Cardiovascular Diseases; CD40 Ligand; Chemokines, CC; Cytokines; Desmosine; Fibrinogen; Humans; Inflammation; Intercellular Adhesion Molecule-1; Isodesmosine; Lung Neoplasms; Matrix Metalloproteinases; Natriuretic Peptide, Brain; Osteoprotegerin; Pulmonary Disease, Chronic Obstructive; Pulmonary Surfactant-Associated Protein D; Serum Amyloid A Protein; Severity of Illness Index; Telomere; Uteroglobin

We performed a prospective, randomized clinical study to assess whether prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, reduces the incidence of postoperative atrial fibrillation.. Postoperative atrial fibrillation is a well recognized complication after lung cancer surgery, with an incidence as high as 30%. Perioperative increase of NT-proBNP has been demonstrated to be a strong independent predictor of postoperative atrial fibrillation in this setting.. NT-proBNP concentration was measured 24 hours before surgery and soon after surgery in 1116 patients. Three hundred twenty (29%) patients showed a high NT-proBNP value and were enrolled: 108 were assigned to the metoprolol group, 102 to the losartan group, and 110 to the control group.. Overall, the incidence of postoperative atrial fibrillation was 20% (n = 64); it was significantly lower in the metoprolol and losartan groups compared with the control group [6%, 12%, and 40%, respectively; relative risk 0.19, 95% confidence intervals (CIs), 0.09-0.37; P < 0.001 in the metoprolol group; and 0.29, 95% CI, 0.16-0.52; P < 0.001 in the losartan group). No significant difference was found when the metoprolol and losartan groups were directly compared (P = 0.21).. A prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with high NT-proBNP levels, significantly reduced the occurrence of postoperative atrial fibrillation.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Female; Humans; Incidence; Losartan; Lung Neoplasms; Male; Metoprolol; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonectomy; Postoperative Complications; Prospective Studies

Congestive heart failure (CHF) as a common comorbidity in patients with lung cancer, especially those of old age. The tumor combined with heart failure makes the reasons of dyspnea more complicated and effective drugs to improve symptoms are urgently needed. Recombinant human B-type natriuretic peptide (rhBNP) is a member of the natriuretic peptide family that exerts cardiovascular effects. The major goal of this study was to study the effect of rhBNP on patients with decompensated heart failure coexisted with lung cancer. Emergency decompensated HF patients with lung cancer admitted for dyspnea were randomly assigned to open label therapy with standard treatment (control group) or standard treatment + rhBNP(rhBNP group) for up to 7 days. Then we recorded the changes of symptoms, examined and followed up every 3 months to evaluate the effect of rhBNP on decompensated heart failure patients with lung cancer. We found that dyspnea, fatigue and edema of lower extremity were significantly improved in the rhBNP group compared to the control group after 7 days of treatment. Survival rate was not significantly different in the mean 18.4 +/- 8.6 months of follow-up. Results from our study suggested that rhBNP significantly improved symptoms in emergency decompensated HF patients with lung cancer admitted for dyspnea in the short-term, but did not improve survival rate in the long-term.

Topics: Adult; Aged; Aged, 80 and over; Dyspnea; Edema; Electrocardiography; Endpoint Determination; Fatigue; Female; Follow-Up Studies; Heart Failure; Hemodynamics; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen; Recombinant Proteins; Survival

We previously reported that patients with preoperative B-type natriuretic peptide levels of 30 pg/mL or more have increased risk of postoperative atrial fibrillation after pulmonary resection. This study evaluated the effects of human atrial natriuretic peptide on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer.. A prospective, randomized study was conducted with 40 patients who had preoperative elevated B-type natriuretic peptide (≥ 30 pg/mL) and underwent a scheduled pulmonary resection for lung cancer. Results were compared between patients who received low-dose human atrial natriuretic peptide and those who received a placebo. The primary end point was the incidence of postoperative atrial fibrillation during the first 4 days after surgery.. The incidence of postoperative atrial fibrillation was significantly lower in the human atrial natriuretic peptide group than in the placebo group (10% vs 60%; P < .001). Patients in the human atrial natriuretic peptide group also showed significantly lower white blood cell counts and C-reactive protein levels after surgery.. Continuous infusion of low-dose human atrial natriuretic peptide during lung cancer surgery had a prophylactic effect against postoperative atrial fibrillation after pulmonary resection in patients with preoperative elevation of B-type natriuretic peptide levels. A larger sample size is needed to establish the safety and efficacy of this intervention.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; C-Reactive Protein; Chi-Square Distribution; Double-Blind Method; Female; Hemodynamics; Humans; Infusions, Parenteral; Japan; Leukocyte Count; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Placebos; Pneumonectomy; Time Factors; Treatment Outcome; Up-Regulation

rhuMAb 2C4 (pertuzumab, RO4368451), a human epidermal growth factor receptor-2 (HER2) targeted antibody that binds to an epitope distinct from trastuzumab, blocks ligand-associated heterodimerization of HER2 with other HER receptor family members. This study evaluated the toxicity, pharmacokinetics and anti-tumor activities of pertuzumab in Japanese patients with solid tumors.. Patients with solid tumors refractory to standard therapy were administered pertuzumab 5, 10, 15, 20 and 25 mg/kg intravenously once every 3 weeks. Grade 3 toxicities were considered as dose limiting. The maximum tolerated dose (MTD) was a dose at which two out of six patients had Grade 3 toxicities.. Eighteen patients, aged 38-66 (median 57) years, with solid tumors were enrolled and a total of 32 cycles of pertuzumab were administered. Toxicities were generally acceptable. Grade 3 elevation of gamma-glutamyl transpeptidase was observed in one patient at 25 mg/kg and was considered to be dose limiting. MTD was not reached up to a dose level of 25 mg/kg. The serum concentration of pertuzumab declined slowly (terminal half-life is approximately 3 weeks). The AUC proportionally increased over the dose range tested. There was limited evidence of activity (stable disease 2; progressive disease 13; and not evaluable 3); however, tumor shrinkage and tumor marker decrease were observed in an ovarian cancer and a non-small-cell lung cancer patient, respectively.. Pertuzumab is well tolerated up to 25 mg/kg. Although objective tumor response was not observed, it is worth evaluating as a flat dose and in combination with other cytotoxics and molecular-targeted agents.

Topics: Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Area Under Curve; Breast Neoplasms; Carcinoma, Non-Small-Cell Lung; Chemotherapy, Adjuvant; Diarrhea; Digestive System Neoplasms; Drug Eruptions; Female; Humans; Hypersensitivity; Lung Neoplasms; Lymphopenia; Male; Middle Aged; Natriuretic Peptide, Brain; Neoplasms; Neoplasms, Germ Cell and Embryonal; Neoplasms, Unknown Primary; Ovarian Neoplasms; Radiotherapy, Adjuvant; Receptor, ErbB-2

Chronic heart failure (CHF) is a complicated syndrome caused by structural and functional abnormalities. Long noncoding RNA (LncRNA) lung cancer-associated transcript 1 (LUCAT1) downregulation inhibits cardiomyocyte apoptosis. This study aimed to measure LUCAT1 expression in patients with CHF and to explore its clinical value on CHF diagnosis and prognosis. A total of 94 patients with CHF and 90 participants without CHF were registered, followed by recording of their clinical characteristics and grading of their cardiac function. LUCAT1 expression in sera of patients with CHF and participants without CHF was detected. The correlation of LUCAT1 with brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) in patients with CHF and the diagnostic efficiency of LUCAT1, BNP, and LUCAT1 combined with BNP on patients with CHF were analyzed. Patients with CHF were treated with conventional drugs and followed up. The LUCAT1 expression in patients with CHF was lower than that in participants without CHF and was downregulated with the increase of New York Heart Association stage. LUCAT1 expression was negatively associated with BNP but positively associated with LVEF in the sera of patients with CHF. The receiver operating characteristic curve of LUCAT1 combined with BNP had better result than that of LUCAT1 and BNP alone. Low LUCAT1 expression indicated poor prognosis of patients with CHF and was an independent prognostic factor for the survival of patients with CHF. To summarize, low lncRNA LUCAT1 expression might help diagnose and predict the poor prognosis of CHF.

Topics: Chronic Disease; Heart Failure; Humans; Lung Neoplasms; Natriuretic Peptide, Brain; Prognosis; RNA, Long Noncoding; Stroke Volume; Ventricular Function, Left

Today, cancer ranks as one of the leading causes of death. Despite the large number of novel available therapies, radiotherapy (RT) remains as the most effective non-surgical method to cure cancer patients. In fact, approximately 50% of all cancer patients receive some type of RT and among these 60% receive RT-treatment with a curative intent. However, as occurs with any other oncological therapy, RT treated patients may experience toxicity side effects that range from moderate to severe. Among these, cardiotoxicity represents a significant threat for premature death. Current methods evaluate cardiotoxic damage based on volumetric changes in the Left Ventricle Ejected Fraction (LVEF). Indeed, a 10% drop in LVEF is commonly used as indicator of cardiotoxicity. More recently, a number of novel techniques have been developed that significantly improve specificity and sensitivity of heart's volumetric changes and early detection of cardiotoxicity even in asymptomatic patients. Among these, the Strain by Speckle Tracking (SST) is a technique based on echocardiographic analysis that accurately evaluates myocardial deformation during the cardiac cycle (ventricular and atrial function). Studies also suggest that Magnetic Resonance Imaging (MRI) is a high-resolution technique that enables a better visualization of acute cardiac damage.. This protocol will evaluate changes in SST and MRI in cancer patients that received thoracic RT. Concomitantly, we will assess changes in serum biomarkers of cardiac damage in these patients, including: high-sensitivity cardiac Troponin-T (hscTnT), N-Terminal pro-Brain Natriuretic Peptide (NTproBNP) and Circulating Endothelial Cells (CECs), a marker of endothelial dysfunction and vascular damage.. The presented protocol is to our knowledge the first to prospectively and with a multimodal approach, study serological and image biomarkers off early cardiac damage due to radiotherapy. With a practical clinical approach we will seek early changes that could potentially be in the future be linked to clinical mayor events with consequences for cancer survivors.

Topics: Breast Neoplasms; Cardiotoxicity; Clinical Protocols; Echocardiography; Endothelial Cells; Esophageal Neoplasms; Female; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Myocardial Contraction; Natriuretic Peptide, Brain; Neoplasms; Peptide Fragments; Radiation Dosage; Radiation Injuries; Stroke Volume; Troponin T; Ventricular Dysfunction, Left

Topics: Adult; Aged; Aged, 80 and over; Air Pollutants; Air Pollution; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Antigens, Surface; Antineoplastic Agents; Antioxidants; Antiviral Agents; Aporphines; Atherosclerosis; Benzoyl Peroxide; beta Catenin; Biofilms; Biomarkers; Brain; Cannabis; Carcinoma, Squamous Cell; Case-Control Studies; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Cell Line; Cell Line, Tumor; Cell Movement; Cell Proliferation; Cell Survival; Child; China; Chlorides; Chlorophyll; Cholesterol, LDL; Coinfection; Corylus; Cross-Sectional Studies; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Developmental Disabilities; Disease Models, Animal; Drug Evaluation, Preclinical; Drug Screening Assays, Antitumor; Electroencephalography; Environmental Exposure; Enzyme Inhibitors; Epilepsy, Generalized; Ethnicity; Female; Fertilization in Vitro; Fluorescent Dyes; Follow-Up Studies; Forecasting; Glutamate Carboxypeptidase II; Glycine; Half-Life; Head and Neck Neoplasms; Health Communication; Heart Ventricles; Hepacivirus; Hepatitis C; Heterosexuality; HIV Infections; Humans; Hypercholesterolemia; Immunoassay; Inhalation Exposure; Isocitrate Dehydrogenase; Laryngeal Neoplasms; Ligands; Light; Lipopolysaccharide Receptors; Liver Cirrhosis; Lung; Lung Neoplasms; Magnetic Resonance Imaging, Cine; Male; Maternal Age; Mechanical Phenomena; Mice; Mice, Nude; Mice, SCID; Microglia; MicroRNAs; Microscopy, Fluorescence; Microsomes, Liver; Middle Aged; Minority Groups; Mitochondrial Membrane Transport Proteins; Models, Biological; Molecular Structure; Molecular Weight; Monte Carlo Method; Muscle Hypotonia; Mutagenesis, Site-Directed; Mutation, Missense; Natriuretic Peptide, Brain; Neoplasms; Nickel; Nitric Oxide; Optical Imaging; Oxides; Particle Size; Particulate Matter; PCSK9 Inhibitors; Peptide Fragments; Phenotype; Photochemotherapy; Photosensitizing Agents; Phytochemicals; Piper; Placenta Growth Factor; Plant Extracts; Plant Leaves; Plant Stems; Platinum; Point-of-Care Testing; Population Surveillance; Postpartum Period; Pregnancy; Pregnancy, Twin; Prevalence; Prospective Studies; Prostatic Neoplasms; Pseudomonas aeruginosa; Pyridines; Pyridones; Racial Groups; Rats; Respiratory Physiological Phenomena; Retrospective Studies; Risk Factors; RNA, Long Noncoding; Semiconductors; Sexual and Gender Minorities; Sexual Behavior; Social Media; Sodium; Solubility; Stereoisomerism; Stochastic Processes; Structure-Activity Relationship; Substance-Related Disorders; Sustained Virologic Response; Sweat; Temperature; Time Factors; Tissue Distribution; Titanium; Transplantation, Heterologous; Tumor Cells, Cultured; Tungsten; Tyramine; United States; Up-Regulation; Ventricular Dysfunction, Left; Ventricular Function, Left; Veterans; Xenograft Model Antitumor Assays; Young Adult

We measured peak oxygen consumption (VO

Topics: Aged; Biomarkers; Breast Neoplasms; Cancer Survivors; Cardiorespiratory Fitness; Cohort Studies; Female; Heart; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen Consumption; Peptide Fragments; Radiation Injuries; Radiotherapy Dosage

GDF-15 is an established cardiovascular risk marker but is equally implicated in tumour biology. Elevated levels of GDF-15 have indeed been observed in distinct tumour entities. This study aimed to explore the relation of GDF-15 to other cardiac biomarkers and the general association of GDF-15 on prognosis in an unselected cohort of treatment-naïve cancer patients.. We prospectively enrolled 555 consecutive patients at time of diagnosis of malignant disease prior receiving anticancer therapy. Plasma GDF-15 concentrations were determined alongside other cardiac and routine laboratory markers. All-cause mortality was defined as primary endpoint.. GDF-15 levels were 338 ng/L (IQR:205-534) for the total cohort, and values were comparable for different tumour entities except breast cancer. Metastatic disease was characterized by higher plasma GDF-15 [435 ng/L (IQR:279-614) vs 266 ng/L (IQR:175-427), P < .001]. GDF-15 correlated positively with inflammatory status reflected by CRP, SAA and IL-6 [r = .31, P < .001, r = .23, P < .001 and r = .14, P = .002] and cardiac biomarkers as NT-proBNP, hsTnT, MR-proADM and CT-proET-1 [r = .46; r = .46; r = .59 and r = .50; P < .001 for all]. GDF-15 was significantly associated with all-cause mortality after multivariate adjustment [adj.HR for ln(GDF-15) 1.78, 95%CI:1.47-2.16, P < .001]. There was a significant interaction between solid and haematological malignancies with loss of association of GDF-15 with outcome in myelodysplastic and myeloproliferative disease.. Elevated plasma GDF-15 is associated with progressing disease severity and poor prognosis in solid tumours of treatment-naïve cancer patients. GDF-15 increase is accompanied by worsening systemic inflammation and a subclinical functional impairment of different organs including the heart. GDF-15 represents a promising target for our pathophysiologic understanding in cardio-oncology linking conditions of both cardiac and neoplastic disease.

Topics: Adrenomedullin; Aged; Breast Neoplasms; C-Reactive Protein; Cause of Death; Endothelin-1; Female; Gastrointestinal Neoplasms; Glycopeptides; Growth Differentiation Factor 15; Humans; Interleukin-6; Lung Neoplasms; Male; Middle Aged; Mortality; Myelodysplastic Syndromes; Myeloproliferative Disorders; Natriuretic Peptide, Brain; Neoplasm Metastasis; Neoplasms; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies; Protein Precursors; Serum Amyloid A Protein; Troponin T

Elevated BNP is associated with adverse cardiac outcomes after noncardiac surgery. We assessed BNP values as markers of perioperative fluid status and their correlation with major/cardiopulmonary (CP) complications following CRS + HIPEC.. Fluid balance, BNP levels, and morbidity data were collected for all patients undergoing CRS + HIPEC between 6/2014 and 2/2016.. One hundred and twenty-nine patients underwent CRS + HIPEC for appendiceal adenocarcinoma (n = 99), mesothelioma (n = 16), and colon cancer (n = 14). Less than 10% had CP comorbidities. The median PCI was 14 (range 4-39); 89% underwent CC0/1 resection (n = 115). Median blood loss (EBL) was 497 mL (50-2700). Major complications (Clavien III-V) occurred in 16 (12%), CP in 17 (13%), and major/CP in 24 (18%). Thirty-day mortality occurred in 2 (1.5%). Elevated BNP on POD1 correlated with increased risk of major/CP complications (OR 2.2, P = 0.052). This was most pronounced in the 25 patients receiving cisplatin: for each 100 unit increase in POD1 BNP the OR for major/CP complication was 7.4 versus 1.2 for the remaining patients, P = 0.083. Multivariate analysis identified increased EBL (OR 4.1 P = 0.011) and a trend toward increased BNP on POD1 (OR for each 100 unit increase 2.0, P = 0.10) as risk factors for major/CP complications.. Postoperative BNP measurement after CRS + HIPEC may guide postoperative fluid resuscitation and facilitate identification of patients at risk for major and/or cardiopulmonary complications.

Topics: Adenocarcinoma; Adult; Aged; Appendiceal Neoplasms; Brain; Colonic Neoplasms; Combined Modality Therapy; Cytoreduction Surgical Procedures; Female; Humans; Hyperthermia, Induced; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Natriuretic Peptide, Brain; Neoplasms; Predictive Value of Tests; Retrospective Studies; Young Adult

Acute kidney injury (AKI) frequently occurs in several medical and surgical settings, and it is associated with increased morbidity and mortality. In patients undergoing lung cancer surgery, AKI has not been fully investigated. We prospectively evaluated the incidence, clinical relevance, and risk factors of AKI in patients undergoing lung cancer surgery. Moreover, we estimated the accuracy of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the prediction of AKI.. Patients undergoing lung cancer surgery were included in the study. Plasma NT-proBNP was measured before and soon after surgery. Postoperative AKI was defined according to the Acute Kidney Injury Network (AKIN) classification.. A total of 2179 patients were enrolled. Of them, 222 (10%) developed AKI and had a more complicated in-hospital clinical course (overall complication rate: 35% vs. 16%; P < 0.0001), and a longer hospital stay (10 ± 7 vs. 7 ± 4 days; P < 0.0001). The incidence of AKI increased in parallel with the extent of lung resection. Among the independent predictors of AKI, serum creatinine (area under the curve [AUC] 0.70 [95% CI 0.67-0.74]) and NT-proBNP (AUC 0.71 [95% CI 0.67-0.74]) provided the highest predictive accuracy, and their combination further significantly improved AKI prediction (AUC 0.74 [95% CI 0.71-0.77]). No difference in AKI prediction was observed between preoperative and postoperative NT-proBNP (P = 0.84).. Acute kidney injury occurs in 10% of patients undergoing lung cancer surgery, and it is associated with a high incidence of postoperative complications. The risk of AKI can be accurately predicted by the combined evaluation of preoperative serum creatinine and NT-proBNP.

Topics: Acute Kidney Injury; Aged; Biomarkers; Female; Humans; Incidence; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Postoperative Complications; Prognosis; Risk Assessment; Risk Factors

Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are categorized as Group 1' in the clinical classification of pulmonary hypertension. No medical therapy has been proven to be effective in patients with PVOD/PCH. Imatinib is a molecular targeted drug and was expected to be effective in patients with pulmonary arterial hypertension. We evaluated its efficacy and safety in patients with PVOD/PCH.. In the present observational study, 9 patients with PVOD/PCH received imatinib. Clinical data including exercise capacity and hemodynamics at baseline and at follow-up were compared. Survival rate of patients treated with imatinib was compared to those of 7 patients who did not treated with imatinib.. Imatinib was prescribed at doses of 100-400 mg/day and was well-tolerated. At follow-up, World Health Organization functional class and brain natriuretic peptide levels significantly improved. Mean pulmonary arterial pressure was significantly reduced (from 56.8 ± 8.3 to 43.7 ± 9.0 mmHg) with preserved cardiac index. Patients were treated with imatinib for 797.2 ± 487.0 days. Seven patients (77.8%) died and 2 patients (22.2%) underwent lung transplantation. Mean survival time in patients treated with imatinib therapy was 1493.7 ± 196.3 days (95% confidence interval, 1108.9-1878.5 days), significantly longer than those without imatinib treatment (713.0 ± 258.1 days, log-rank test, P = 0.04).. Imatinib improved exercise capacity, hemodynamics and survival in patients with PVOD/PCH. In patients with PVOD/PCH, who have no effective medical therapy available, imatinib might function as a bridge to lung transplantation, and may become a potential therapeutic option to improve their survival.

Topics: Adult; Exercise Tolerance; Hemangioma, Capillary; Hemodynamics; Humans; Hypertension, Pulmonary; Imatinib Mesylate; Kaplan-Meier Estimate; Lung Neoplasms; Lung Transplantation; Male; Middle Aged; Natriuretic Peptide, Brain; Protein Kinase Inhibitors; Pulmonary Veno-Occlusive Disease; Severity of Illness Index; Survival Rate; Treatment Outcome; Walk Test; Young Adult

Topics: Aged; Aged, 80 and over; Biomarkers; Breast Neoplasms; Female; Galectin 3; Heart Injuries; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Radiation Injuries; Troponin I

Since lung cancer surgery is still associated with a high complication rate, it is important to efficiently identify patients at high risk for postoperative complications following lung cancer surgery. We previously reported that elderly patients with elevated preoperative B-type natriuretic peptide (BNP) levels (>30 pg/mL) have an increased risk for postoperative atrial fibrillation and cardiopulmonary complications following lung cancer surgery. The objective of this study was to evaluate the clinical utility of BNP-guided risk classification for postoperative complications after lung cancer surgery.. A total of 675 consecutive patients who underwent curative surgery for lung cancer in two specialized thoracic centers between 2007 and 2011 were included in this retrospective study. We evaluated the association between the incidence of postoperative complications and preoperative BNP levels.. Univariable and multivariable stepwise logistic regression analyses revealed that an elevated preoperative BNP level was the most significant predictor of postoperative complications. All patients were classified by their preoperative BNP levels into a normal group (<30 pg/mL), a mildly elevated group (30-100 pg/mL), and a severely elevated group (>100 pg/mL). The incidence of postoperative complications was significantly higher in the severely and mildly elevated groups than in the control group (85 % and 47 % vs. 11 %, P < 0.0001). Furthermore, there were more severe complications and a higher mortality rate in the severely elevated group.. Risk assessment using preoperative BNP levels was clinically useful for the identification of patients at high risk for postoperative complications.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Atrial Fibrillation; Biomarkers; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Pneumonectomy; Pneumonia; Predictive Value of Tests; Preoperative Period; Respiratory Distress Syndrome; Retrospective Studies; Risk Assessment; ROC Curve; Thoracic Surgery, Video-Assisted; Thoracotomy; Young Adult

Non-small-cell lung cancers (NSCLCs) harboring translocations in anaplastic lymphoma kinase (ALK) are highly sensitive to small-molecule ALK kinase inhibitors, such as crizotinib.. We describe a case of post-operative local recurrence of lung adenocarcinoma in an 81 year-old male. He underwent radiation and received chemotherapy with docetaxel, but neither treatment regimen was effective. Following identification of ALK rearrangements, crizotinib treatment was initiated. After treatment with crizotinib for 5 days, adverse events including acute renal failure (grade 2/CTCAE ver4.0) and congestive heart failure (grade 3) occurred. Crizotinib modified treatment was required. Half dose of crizotinib treatment could not control tumor progression. Ultimately, crizotinib was administrated at a dose of 250 mg twice daily every 3 day dosing for 13 months with maintenance of the anti-tumor effect.. This is the first case report that skip schedule was more effective than dose reduction daily in crizotinib administration for ALK rearranged NSCLC patient with severe adverse events.

Topics: Aged, 80 and over; Anaplastic Lymphoma Kinase; Carcinoembryonic Antigen; Carcinoma, Non-Small-Cell Lung; Crizotinib; Drug Administration Schedule; Gene Rearrangement; Humans; Lung Neoplasms; Male; Natriuretic Peptide, Brain; Pyrazoles; Pyridines; Radiography; Receptor Protein-Tyrosine Kinases; Treatment Outcome

To identify risk factors for atrial fibrillation (AF) following lobectomy for a pulmonary malignant tumour.. The outcomes of patients who underwent lobectomy from February 2005 to September 2010 were analysed with respect to the development of postoperative AF.. Among 186 patients, 20 developed AF and these had significantly higher preoperative B-type natriuretic peptide (BNP) than those without AF. A significantly high incidence of AF following pulmonary lobectomy was demonstrated in the group of patients who were male, underwent a thoracotomy, had a high preoperative value of BNP and underwent a left lobectomy. Multivariate analysis revealed that left lobectomy is the only independent risk factor. The area under the receiver-operating characteristic curve for BNP to predict postoperative AF following a left lobectomy for a pulmonary malignant tumour was 0.82 (95% confidence interval 0.70-0.93; P<0.05). A BNP level of 24.1 pg/ml had a sensitivity of 90.9% and a specificity of 56% for predicting postoperative AF following left lobectomy for a pulmonary malignant tumour.. Left lobectomy is the only independent risk factor for postoperative AF. Elevated BNP is the risk factor for postoperative AF in patients undergoing left pulmonary lobectomy.

Topics: Aged; Atrial Fibrillation; Chi-Square Distribution; Female; Humans; Lung Neoplasms; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Pneumonectomy; Predictive Value of Tests; Risk Factors; ROC Curve

Accurate detection and monitoring of disease-related biomarkers is important in understanding pathophysiology. We devised a rapid immunoreaction system that uses submicrometer polymer-coated fluorescent ferrite (FF) beads containing both ferrites (magnetic iron oxide) and fluorescent europium complexes.. FF beads were prepared by encapsulation of hydrophobic europium complexes into the polymer layers of affinity magnetic beads using organic solvent. A sandwich immunoassay using magnetic collection of antibody-coated FF beads to a specific place was performed. Brain natriuretic peptide and prostate-specific antigen were selected as target detection antigens to demonstrate the feasibility of this approach. An immunohistochemical staining using magnetic collection of antibody-coated FF beads onto carcinoma cell samples was also performed.. The sandwich immunoassays, taking advantage of the magnetic collection of antibody-coated FF beads, detected target antigens within 5 min of sample addition. Without magnetic collection, the sandwich immunoassay using antibody-coated FF beads required long times, similar to conventional immunoassays. Using the magnetic collection of antibody-coated FF beads, immunohistochemical staining enabled discrimination of carcinoma cells within 20 min.. This proof of principle system demonstrates that immunoreactions involving the magnetic collection of antibody-coated FF beads allow acceleration of the antigen-antibody reaction. The simple magnetic collection of antibody-coated FF beads to a specific space enables rapid detection of disease-related biomarkers and identification of carcinoma cells.

Topics: Biomarkers; Breast Neoplasms; Carcinoma, Squamous Cell; Cell Line, Tumor; Coordination Complexes; ErbB Receptors; Esophageal Neoplasms; Europium; Female; Ferric Compounds; Fluorescent Dyes; Humans; Immunoassay; Lung Neoplasms; Magnets; Male; Natriuretic Peptide, Brain; Prostate-Specific Antigen; Small Cell Lung Carcinoma

The objective of the present study was to evaluate the clinical effects of human atrial natriuretic peptide (hANP) on post-operative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer.. A retrospective study involving 44 consecutive patients aged ≥75 years who had elevated pre-operative B-type natriuretic peptide levels (≥30 pg/ml) and underwent a scheduled pulmonary resection for lung cancer in two specialized thoracic centres between April 2008 and March 2010. Results were compared between the patients who did and did not receive hANP during the perioperative period. The primary endpoint was the incidence of post-operative cardiopulmonary complications. Post-operative haemodynamics, white blood cell (WBC) counts and C-reactive protein (CRP) levels were also examined.. The incidence of post-operative cardiopulmonary complications was significantly lower in the hANP group than that in the control group (26 vs. 86%, P < 0.0001). Patients in the hANP group showed significantly lower WBC counts and serum CRP levels post-operatively.. Continuous infusion of low-dose hANP during lung cancer surgery had a prophylactic effect on post-operative cardiopulmonary complications in elderly lung cancer patients. (. JPRN-UMIN000003631).

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Drug Administration Schedule; Drug Evaluation; Female; Humans; Infusions, Intravenous; Leukocyte Count; Lung Diseases; Lung Neoplasms; Male; Natriuretic Peptide, Brain; Perioperative Care; Postoperative Complications; Retrospective Studies; Treatment Outcome

Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are rare causes of pulmonary hypertension. There is no proven medical therapy to treat these diseases, and lung transplantation is thought to be the only cure. Administration of vasodilators including epoprostenol sometimes causes massive pulmonary edema and could be fatal in these patients.. Eight patients were treated with epoprostenol for 387.3±116.3 days (range, 102-1,063 days), who were finally diagnosed with PVOD or PCH by pathological examination. The maximum dose of epoprostenol given was 55.3±10.7 ng·kg(-1)·min(-1) (range, 21.0-110.5 ng·kg(-1)·min(-1)). With careful management, epoprostenol therapy significantly improved the 6-min walk distance (97.5±39.2 to 329.4±34.6 m, P<0.001) and plasma brain natriuretic peptide levels (381.3±136.8 to 55.2±14.4 pg/ml, P<0.05). The cardiac index significantly increased from 2.1±0.1 to 2.9±0.3 L·min(-1)·m(-2) (P<0.05). However, pulmonary artery pressure and pulmonary vascular resistance were not significantly reduced. For 4 patients, epoprostenol therapy acted as a bridge to lung transplantation. For the other patients who had no chance to undergo lung transplantation, epoprostenol therapy was applied for 528.0±216.6 days and the maximum dose was 63.9±19.0 ng·kg(-1)·min(-1).. This study data suggest that cautious application of epoprostenol can be considered as a therapeutic option in patients with PVOD and PCH.

Topics: Adolescent; Adult; Antihypertensive Agents; Biomarkers; Blood Pressure; Child; Epoprostenol; Exercise Tolerance; Female; Hemangioma, Capillary; Humans; Hypertension, Pulmonary; Japan; Lung Neoplasms; Lung Transplantation; Male; Natriuretic Peptide, Brain; Pulmonary Veno-Occlusive Disease; Recovery of Function; Time Factors; Treatment Outcome; Vascular Resistance; Vasodilator Agents

Weight gain with oedema development is a complication of major surgical procedures with an incidence as high as 40%. Fluid retention is not always clinically evident and it is reported despite fluid-restriction regime. The causes are several and not totally clear. We performed a prospective study to assess the amount of fluid accumulation and redistribution observed after major thoracic surgery.. In 49 patients submitted to lobectomy with systematic lymph node dissection for lung cancer, we measured preoperatively and on the postoperative days 1, 2, 4 and 7, body weight, fluid balance, brain natriuretic peptide (BNP) and bioimpedance analysis (BIA)-derived parameters resistance (R) and reactance (X(c)).. The postoperative course was characterised by significant changes. Mean increase in body weight was 2.7 kg ((1.9-3.4); p<0.001) on postoperative day 2. Most of the patients had a negative basal fluid balance (-244 ml (-520 to -50)), whereas, on postoperative day 2, we observed a positive and significant change (+968 ml (646-1456), p<0.001)). Total body R and X(c) fell on the first day (p<0.001), anticipating the changes in weight and fluid balance. BNP increased on day 1, immediately after surgery, and remained significantly above basal values for the entire observation period (p<0.001), in the absence of clinical signs of heart failure.. The three methods used consistently showed a significant fluid retention over the course of the study. BIA was an easy, reproducible and non-invasive method for the estimation and early detection of fluid retention. Increase in BNP may be related to the systemic reaction to stress and to the decreased pulmonary vascular bed. We found no correlation between fluid retention and length of anaesthesia, sex, age, blood loss and body mass index. The clinical and prognostic implication of weight gain may be relevant to patient's health.

Topics: Aged; Biomarkers; Edema; Electric Impedance; Electrodiagnosis; Feasibility Studies; Female; Humans; Lung Neoplasms; Lymph Node Excision; Male; Middle Aged; Natriuretic Peptide, Brain; Pneumonectomy; Prospective Studies; Water-Electrolyte Imbalance; Weight Gain

The objective of the present study was to evaluate the utility of B-type natriuretic peptide for prediction of postoperative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer.. A prospective observational study was performed involving 80 consecutive patients aged 75 years or older who underwent a scheduled pulmonary resection for lung cancer in two specialized thoracic centers between January 2008 and June 2010. Baseline clinical details were obtained, and spirometry and examination of serum B-type natriuretic peptide levels were performed before surgery. The primary endpoint was the incidence of postoperative cardiopulmonary complications.. Postoperative cardiopulmonary complications were identified in 34 (43%) patients; these patients had significantly higher preoperative B-type natriuretic peptide levels than those without cardiopulmonary complications (84.0±93.7 pg/mL vs 22.0±18.2 pg/mL; p<0.0001). The area under the receiver operating characteristic curve for B-type natriuretic peptide to predict postoperative cardiopulmonary complications after pulmonary resection for lung cancer was 0.85 (95% confidence interval 0.76 to 0.94; p<0.0001). A B-type natriuretic peptide value of 30 pg/mL had a sensitivity of 79% and a specificity of 83% for predicting postoperative cardiopulmonary complications after pulmonary resection for lung cancer. The incidences of both cardiovascular and respiratory complications were significantly higher in patients with preoperative B-type natriuretic peptide levels of 30 pg/mL or more.. Preoperative B-type natriuretic peptide level could be a useful predictor of postoperative cardiopulmonary complications in elderly patients after pulmonary resection for lung cancer.

Topics: Age Factors; Aged; Female; Follow-Up Studies; Heart Diseases; Humans; Immunoenzyme Techniques; Incidence; Japan; Lung Neoplasms; Male; Natriuretic Peptide, Brain; Pneumonectomy; Pneumonia; Prognosis; Prospective Studies; Respiratory Distress Syndrome; Risk Factors; ROC Curve; Survival Rate; Thoracic Surgery, Video-Assisted

To evaluate the usefulness of atrial natriuretic peptide (ANP) and brain B-type natriuretic peptide (BNP) for predicting postoperative atrial fibrillation (AF), we determined the changes in perioperative ANP and BNP levels in patients undergoing pulmonary resection for lung cancer.. This prospective observational study was conducted during the 10-month period from July 2007 to April 2008. Eighty patients with lung cancer underwent lobectomy, segmentectomy or wedge resection. Preoperative evaluations included spirometry and examinations of plasma ANP and BNP-levels, which were also determined on postoperative days 1, 3 and 7.. Postoperative AF was identified in 22 (28%) of the patients, and those had significantly higher preoperative ANP and BNP levels as compared with patients without AF. During the postoperative course, patients with postoperative AF also had significantly higher ANP and BNP-levels. The area under the receiver-operating characteristic curve for BNP to predict postoperative AF following pulmonary resection for lung cancer was 0.90 (95% confidence interval (CI), 0.82-0.98; p<0.001). A BNP value of 30pgml(-1) had a sensitivity of 77% and a specificity of 93% for predicting postoperative AF following pulmonary resection for lung cancer.. Preoperative BNP level seems to be an appropriate predictor of AF after pulmonary resection.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Female; Forced Expiratory Volume; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Pneumonectomy; Predictive Value of Tests; Prognosis; Prospective Studies; Vital Capacity

Postoperative atrial fibrillation (AF) is a well-known complication occurring after thoracic surgery. B-type natriuretic peptide has recently been investigated as a predictive marker of postoperative AF after cardiac surgery. The aim of this study was to evaluate a definite cut-off for N-terminal pro-B type natriuretic peptide (NT-proBNP) in predicting postoperative AF in lung cancer patients. NT-proBNP was determined before and after surgery in 400 patients. Cardiac function was monitored by continuous postoperative ECG and clinical cardiological evaluation. AF occurred in 18% of the patients. Receiver operating characteristic curve analyses identified a cut-off of 182.3 ng l(-1) as the one with the highest sensitivity and specificity. Perioperative increased levels of NT-proBNP seem to predict postoperative AF in patients undergoing thoracic surgery, and a single cut-off of 182.3 ng l(-1) can be used to select high-risk patients who could receive preventive therapy, leading to a considerable decrease in the total costs associated with the management of this complication.

Topics: Aged; Area Under Curve; Atrial Fibrillation; Biomarkers; Electrocardiography; Female; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Peptides; Risk; ROC Curve; Sensitivity and Specificity

A 74-year-old man with metastatic renal cell carcinoma and a history of cardiac failure was treated with sunitinib malate. MUGA echocardiography could not detect a relevant change in the ejection fraction although the clinical situation of the patient worsened dramatically. The only parameter to hint at the deteriorated cardiac function was plasma N-terminal pro-brain natriuretic peptide (BNP). Finally, the patient died after only one cycle of sunitinib treatment. We propose to prospectively include BNP for the early detection of cardiovascular decompensation in high-risk patients. Future studies concerning the relevance of BNP in drug-related cardiotoxicity are urgently needed.

Topics: Aged; Carcinoma, Renal Cell; Echocardiography; Heart Failure; Humans; Indoles; Kidney Neoplasms; Lung Neoplasms; Male; Natriuretic Peptide, Brain; Neoplasm Metastasis; Prognosis; Pyrroles; Retrospective Studies; Sunitinib; Thrombosis

Radiation therapy to the mediastinum and breast can be associated with cardiac complications. Cardiac damage may manifest early during radiation therapy or occur late, years after radiation therapy has been finished.. Myocardial damage is associated with the release of both troponin I (TnI) and brain natriuretic peptide (BNP). The current study sought to determine whether radiation treatment to the mediastinum and breast leads to the release of cardiac biomarkers.. The study comprised 23 patients: 18 with lung cancer and 5 with breast cancer. Radiation therapy was performed for up to 6 weeks. Total radiation dose was >45 Gy in each patient with a dose of 1.8 Gy per fraction. Blood samples to determine TnI and BNP were taken before and once a week during radiation therapy. Echocardiography was done before and after radiation had been finished.. Two patients died during the study. Both TnI and BNP levels increased significantly during the study (log(10) scale); however, absolute and mean values remained on a relatively low level (mean preradiation and postradiation TnI: 0.007 +/- 0.008, 0.014 +/- 0.01 ng/ml; mean preradiation and postradiation BNP: 123 +/- 147, 159 +/- 184 pg/ml).. Radiation therapy leads to cardiac cell damage and changes in the left ventricular loading conditions as suggested by a significant increase of the cardiac biomarkers TnI and BNP. Determination of serum levels seems to be superior to echocardiography in detecting radiation-induced cardiac damage. Serial measurements of cardiac biomarkers may facilitate the management of patients undergoing radiation therapy and may help to define subgroups at high risk of developing heart failure.

Topics: Aged; Biomarkers; Breast Neoplasms; Echocardiography; Female; Heart; Heart Failure; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Radiation Dosage; Radiation Injuries; Troponin I

The primary aim of this study was to evaluate a combined therapeutic intervention, including the dual endothelin receptor antagonist bosentan, in patients with carcinoid heart disease (CaHD). The efficacy of the treatment protocol was investigated using serological, echocardiographic, and clinical markers.. Since 2003, 40 patients with neuroendocrine tumours were identified; 14 had echocardiographic findings consistent with CaHD. Six of the 14 patients with CaHD and a New York Heart Association (NYHA) functional class >or= III received bosentan and were eligible for inclusion in this study.. N-terminal pro-brain natriuretic peptide (NT-pro-BNP) had decreased 6 months after treatment with bosentan (median: 646 pg/ml vs. 400.5 pg/ml; p = 0.02); the right ventricular systolic pressure had decreased after 3 and 6 months (median: 69 mmHg vs. 61 mmHg, p = 0.02; median: 69 mmHg vs. 48.5 mmHg, p = 0.02); the 6-minute walk distance (6MWD) had significantly improved after 3 and 6 months of treatment (median: 293.5 vs. 406.5 m; p = 0.02; median: 293.5 vs. 578.5 m; p = 0.02). The NYHA functional class improved in 5/6 patients receiving bosentan.. Combined treatment with bosentan is effective in patients with CaHD, based on functional class, 6MWD, and NT-pro-BNP. Further clarification of the CaHD fibrosis pathogenesis is needed to facilitate development of targeted antifibrotic therapeutic agents.

Topics: Aged; Antihypertensive Agents; Antineoplastic Combined Chemotherapy Protocols; Bosentan; Carcinoid Heart Disease; Combined Modality Therapy; Echocardiography, Doppler; Endothelin Receptor Antagonists; Exercise Test; Female; Follow-Up Studies; Gastrointestinal Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Ovarian Neoplasms; Peptide Fragments; Sulfonamides

The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is affected by many known factors. Our study aimed to evaluate whether other factors, in particular lung cancer, could be responsible for an increase in NT-proBNP levels in a population with no known risk factors for elevated NT-proBNP.. This study was based on the RIABO (Recueil de l'Ischémie au Bloc Opératoire) database, a single-center registry that prospectively records in elective noncardiac surgery. Patients aged > 75 years and those presenting with 1 or more known risk factors for high NT-proBNP were excluded. Patients were divided into 2 groups according to preoperative NT-proBNP levels: (≥ 125 pg/mL or < 125 pg/mL).. Between October 2005 and February 2007, 439 patients were eligible for inclusion. Among 35 patients with lung cancer, 26 (74%) had elevated NT-proBNP (≥ 125 pg/mL), versus 9 (26%) with NT-proBNP < 125 pg/mL (P < .0001). By multivariate analysis, the presence of lung cancer was an independent risk factor for a level of NT-proBNP ≥ 125 pg/mL (odds ratio, 7; 95% CI, 2.9-17; P < .0001). We also observed an independent relationship between NT-proBNP ≥ 125 pg/mL and age, female sex, smoking status, and C-reactive protein levels.. In our study, patients with lung cancer were 7 times more likely to have elevated NT-proBNP (≥ 125 pg/mL). The presence of lung cancer should therefore be taken into account when interpreting NT-proBNP levels. Further studies are warranted to explore the diagnostic value of this marker in lung cancer and to identify the cause of the elevation.

Topics: Aged; Biomarkers; C-Reactive Protein; Female; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Regression Analysis; Risk Factors; ROC Curve

Sunitinib is an oral, multitargeted tyrosine kinase inhibitor that has been approved for the treatment of metastatic renal cell carcinoma. Although the majority of sunitinib-treated patients receive a clinical benefit, almost a third of the patients will not respond. Currently there is no available marker that can predict for response in these patients.. We estimated the plasma levels of NT-pro-BNP (the N-terminal precursor of brain natriuretic peptide) in 36 patients that were treated with sunitinib for metastatic clear-cell renal carcinoma.. From the 36 patients, 9 had progressive disease and 27 obtained a clinical benefit (objective response or disease stabilization). Increases in plasma NT-pro-BNP were strongly correlated to clinical outcome. Patients with disease progression increased plasma BNP at statistically significant higher levels than patients that obtained a clinical benefit, and this was evident from the first 15 days of treatment (a three-fold increase in patients with progressive disease compared to stable NT-pro-BNP levels in patients with clinical benefit, p < 0.0001). Median progression-free survival was 12.0 months in patients with less than 1.5 fold increases (n = 22) and 3.9 months in patients with more than 1.5 fold increases in plasma NT-pro-BNP (n = 13) (log-rank test, p = 0.001).. This is the first time that a potential "surrogate marker" has been reported with such a clear correlation to clinical benefit at an early time of treatment. Due to the relative small number of accessed patients, this observation needs to be further addressed on larger cohorts. More analyses, including multivariate analyses are needed before such an observation can be used in clinical practice.

Topics: Adult; Aged; Antineoplastic Agents; Biomarkers; Bone Neoplasms; Carcinoma, Renal Cell; Female; Humans; Indoles; Kidney Neoplasms; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Pyrroles; Sunitinib

B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP) are important diagnostic tools for patients with suspected cardiac disorders. The aim of this study was to evaluate the predictive value of plasma NT-pro-BNP in identifying cardiac metastases in patients with non-small cell lung cancer (NSCLC) and dyspnoea.. A total of 120 patients, median age 62 years (range 46-83), with NSCLC and dyspnoea were studied. Patients with heart failure or documented coronary artery disease were excluded. Echocardiographic imaging was used to detect cardiac metastases and estimate global left ventricular function. Ejection fraction and E/A ratio from transmitral inflow pattern were calculated. Plasma NT-pro-BNP was also measured. 72 patients (72/120, 60%) with cardiac metastases were identified.. NT-pro-BNP was significantly higher in patients with metastases (1347.5 +/- 1004.30 pg/ml vs. 159.02 +/- 93.29 pg/ml; p = 0.001). No differences between groups, regarding s-creatinine (p = 0.45), haemoglobin (p = 0.71), left ventricular hypertrophy (p = 0.91), and diastolic dysfunction (p = 0.79), were observed.. Plasma NT-pro-BNP is remarkably elevated in patients with NSCLC and myocardial/pericardial infiltrations and may be used as a sensitive marker for detecting cardiac metastases in these patients.

Topics: Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; Female; Heart Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Reproducibility of Results; Sensitivity and Specificity

To evaluate the value of the myocardial biochemical markers including creatine kinase MB isoenzyme (CK-MB), cardiac isoform of Tropnin-T (cTnT) and N-termimal pro-brain natriuretic peptide (NT-proBNP) and electrocardiogram (ECG) in monitoring the cardiotoxicity of recombinant human endostatin (rh-endostatin) in cancer patients.. Forty cancer patients were divided into two groups and received rh-endostatin in addition to chemotherapy (group A, n=24) or chemotherapy only (Group B, n=24). Serum CK-MB, cTnT levels and plasma NT-proBNP levels were measured and the ECG was recorded in all the patients before and after each of the two therapy cycles.. In group A, serum CK-MB, cTnT and plasma NT-proBNP levels were significantly increased after the treatment in comparison with the baseline levels (P<0.05), but such increment was not observed in group B (P>0.05). With comparable baseline levels of CK-MB, cTnT and NT-proBNP before the treatment (P>0.05), patients in group A showed significantly higher levels of the indices than those in group B after each therapy cycle (P<0.05). Increased ECG abnormality were observed after rh-endostatin treatment in Group A (P<0.05) at a rate significantly higher than that of Group B after the second treatment cycle (P<0.05).. Rh-endostatin has definite cardiotoxicity, and detection of the myocardial biochemical markers of CK-MB, cTnT and NT-proBNP may help predict the occurrence of cardiotoxicity.

Topics: Adult; Aged; Antineoplastic Agents; Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; Creatine Kinase, MB Form; Endostatins; Female; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Ovarian Neoplasms; Peptide Fragments; Recombinant Proteins; Risk Assessment; Troponin T

Cardiotoxicity is a known consequence of thoracic irradiation and there are multiple overlapping risk factors for cardiac disease and thoracic malignancies. In this study, we quantified the impact of thoracic (chemo)radiation on cardiac troponin T (TnT), creatine kinase-myocardial band (CK-MB) and aminoterminal pro-brain natriuretic peptide (NT-proBNP). Thirty patients receiving radiation therapy to the thorax with or without concurrent chemotherapy were evaluated. Serum was collected at baseline, 2 weeks into treatment and at the completion of radiation therapy. TnT, CK-MB and NT-proBNP were quantified using commercially available immunoassays. Cardiac dosimetric parameters and clinical risk factors were examined. In 29 of 30 patients, serum TnT remained undetectable (<0.01ng/mL) throughout (chemo)radiation. In the one patient with detectable serum TnT, levels did not change significantly with treatment. Similarly, thoracic (chemo)radiation did not cause statistically significant elevations in serum CK-MB and NT-proBNP. Thus, contemporary thoracic (chemo)radiation does not commonly result in elevations of serum TnT, CK-MB or NT-proBNP. Elevations in these markers during treatment merit further evaluation.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Creatine Kinase, MB Form; Esophageal Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Risk Factors; Small Cell Lung Carcinoma; Thymus Neoplasms; Troponin T

Postoperative infections and cardiac events are the major morbidity factors after thoracic surgery and dominating causes of death. Therefore, a sensitive blood marker is needed for an early diagnosis of complications. Twenty-two patients admitted with lung cancer were enrolled in this study. Procalcitonin, brain natriuretic peptide, C-reactive peptide and interleukin-6 levels were recorded preoperatively and postoperatively on days 1-5. Laboratory values of patients with cardiac or infectious complications were compared to patients without complications. During postoperative course procalcitonin and brain natriuretic peptide levels elevated in all patients, but both had higher peak levels in patients with infectious or cardiac complication than without these complications. Interleukin-6 levels were increased on day one and showed a slower decrease in case of complications than without complications. In general, brain natriuretic peptide and procalcitonin levels are increased in the postoperative course after major pulmonary resection, but cardiac and infectious complications are associated with higher levels and a slower decrease than without complications. Interleukin-6 levels showed a slower decrease in patients with complications in the postoperative course than without complications. So the combination of procalcitonin, brain natriuretic peptide, and interleukin-6 seems to be useful for an optimized postoperative monitoring.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Follow-Up Studies; Heart Diseases; Humans; Interleukin-6; Leukocyte Count; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Pilot Projects; Pneumonectomy; Predictive Value of Tests; Prospective Studies; Protein Precursors; Surgical Wound Infection; Time Factors; Treatment Outcome

Four peptide hormones of a family of six hormones, i.e. atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-natriuretic peptide (CNP), long acting natriuretic peptide (LANP), vessel dilator and kaliuretic peptide, significantly decrease the number of adenocarcinoma cells in culture. The present investigation was designed to determine whether these peptide hormones' effects are specific to adenocarcinomas or whether they might decrease the number of cancer cells of a different type of cancer, i.e. small-cell lung cancer.. These six hormones were evaluated for their ability to decrease the number and/or proliferation of human small-cell lung cancer cells in culture for 24, 48, 72, and 96 h.. Within 24 h, vessel dilator, LANP, kaliuretic peptide, ANP and their intracellular mediator cyclic GMP, each at 1 microM, decreased the number of small-cell lung cancer cells by 63% (P < 0.001), 21% (P < 0.05), 30% (P < 0.05), 39% (P < 0.05), and 31% (P < 0.05), respectively. There was no proliferation in the 3 days following this decrease in cell number. These same hormones decreased DNA synthesis 68% to 82% (P < 0.001). Brain natriuretic peptide and CNP did not decrease the number of small-cell lung cancer cells or inhibit their DNA synthesis at 1 microM or 10 microM concentrations. Dose-response curves revealed that at 100 microM, the vessel dilator decreased 92% of the cancer cells in 24 h while BNP had no effect, but CNP caused a 39% decrease. Western blots revealed that the natriuretic peptide receptors A- and C- were present in these cancer cells.. Five peptide hormones significantly decrease the number of human small-cell lung cancer cells within 24 h and inhibit their proliferation for at least 96 h. Their mechanism of doing so involves inhibition of DNA synthesis mediated in part by cyclic GMP.

Topics: Adenocarcinoma; Atrial Natriuretic Factor; Blotting, Western; Carcinoma, Small Cell; Cell Proliferation; Humans; Lung Neoplasms; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Protein Precursors

From August 1997 to December 2002, 14 consecutive patients with superior vena cava syndrome with the self-expanding endovascular prosthesis. Diagnoses were adenocarcinoma in 6, small cell carcinoma in 4, squamous cell carcinoma in 1, metastatic lung cancer in 2, and invasive thymoma in 1. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured on their admission and perioperative period. Expecting only 1 patient complete symptomatically relieved within 3 days of stent implantation. Superior vena cava pressure or radial pressure of the stent was sufficient to relieve obstruction. Preoperative ANP level were normal, BNP level were increased. Postoperatively both ANP level and BNP level were slightly increased under intravenous dopamine hydrochloride. Implantation of the self-expanding stent endovascular prosthesis for superior vena cava syndrome provides rapid symptomatic relief and improves the patient's quality of life.

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Female; Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prostheses and Implants; Quality of Life; Stents; Superior Vena Cava Syndrome

Topics: Humans; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Embolism

Little is known about alterations in the levels and influence of natriuretic peptide (NP) on cardiopulmonary function after pulmonary resection for lung cancer. This study was designed to investigate the patterns and activity of NP after pulmonary resection.. We investigated changes in plasma A-type (atrial) NP and B-type (brain) NP (BNP) using radioimmunoassay, in lung cancer patients before and after lobectomy (n = 15) or pneumonectomy (n = 10). Patient characteristics, respiratory function, operative time, blood loss, intraoperative fluid administration, and intraoperative urine output in both groups were also compared. Pulmonary hemodynamic variables were monitored continuously.. Plasma concentrations of A-type NP and BNP did not differ between the two groups preoperatively. However, the group undergoing pneumonectomy exhibited higher concentrations of A-type NP and BNP than the group undergoing lobectomy on postoperative days 3 and 7. Alterations in A-type NP and BNP after pulmonary resection therefore differed according to the volume of lung tissue resected. Both mean pulmonary artery pressure and total pulmonary vascular resistance increased significantly in the pneumonectomy group. The total pulmonary vascular resistance on postoperative day 3 correlated with the plasma BNP concentration in the pneumonectomy group.. A-type NP and BNP effectively compensate for the right ventricular dysfunction noted after pulmonary resection, and this is more evident after pneumonectomy than after lobectomy. Changes in ventricular activity associated with changes in plasma BNP and total pulmonary vascular resistance are indicative of cardiopulmonary adjustments after pneumonectomy.

Topics: Aged; Atrial Natriuretic Factor; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Natriuretic Peptide, Brain; Pneumonectomy; Postoperative Complications; Pulmonary Wedge Pressure; Radioimmunoassay; Vascular Resistance

The tumoral production of brain natriuretic peptide (BNP) was studied using 9 small cell lung cancer (SCLC) cell lines which were established from patients with small cell lung cancer. BNP cDNA fragment was generated from 20 microg total RNA which was prepared from the human right cardiac atrium by reverse transcription-based polymerase chain reaction. Expression of BNP mRNA was detected in 30 microg total cellular RNA from these cell lines by RNase protection assays in 5 of 9 SCLC cell lines. Radioimmunoassays using 125I-radiolabeled human BNP(1-32) and antihuman BNP(1-32) antibody detected immunoreactivity in cell pellets from SCLC cell lines which had detectable BNP mRNA. BNP immunoreactivity in the cell pellets corresponds with the data from BNP mRNA analyses. We conclude that SCLC cells have detectable BNP mRNA by RNase protection assay and BNP immunoreactivity in the cells.

Topics: Carcinoma, Small Cell; DNA Primers; DNA, Neoplasm; Gene Expression Regulation, Neoplastic; Humans; Lung Neoplasms; Natriuretic Peptide, Brain; Polymerase Chain Reaction; Radioimmunoassay; RNA, Messenger; RNA, Neoplasm; Tumor Cells, Cultured