Early and late elevation of plasma atrial and brain natriuretic peptides in patients after bone marrow transplantation

Clinical usefulness of bone marrow transplantation (BMT) remains limited by myocardial damage during the post-transplantation period. Measurements of plasma atrial and brain natriuretic peptides (ANP, BNP) during the acute post-transplantation period could serve to monitor cardiac complications since these peptides are known to increase in heart failure depending on its severity. We prospectively analyzed ANP and BNP levels from 14 days before to 100 days after BMT in 46 consecutive patients undergoing allogeneic (n=42) and autologous (n=4) transplantation. Cardiac performance was assessed by echocardiography and radionuclide ventriculography. BNP and ANP levels of the patients on admission (baseline: day-14) were 16.3+/-13.3 pg/ml and 14.4+/-8.8 pg/ml, respectively. There were two different types of changes in the BNP and ANP levels. The 21 patients in group I showed dual peaks of elevation on day 1 (BNP=164.4+/-136.0 pg/ml, P0.01; ANP=44.5+/-35.4 pg/ml, NS) and day 14 (BNP=233.9+/-106.2 pg/ml, P0.01; ANP=142.7+/-154.6 pg/ml, P0.05), whereas the remaining 25 patients in group II had a single peak on day 1 (BNP=124.5+/-124.9 pg/ml, P0.05; ANP=45.2+/-42.4 pg/ml, NS). The left ventricular ejection fraction on day 63 was unchanged in both groups of patients from the baselines. The time to peak filling rate, a parameter of diastolic function in the radionuclide ventriculography, was significantly prolonged in group I patients (by 30+/-53%), whereas unaffected in group II patients. These results suggest that plasma BNP monitoring for 2 weeks after BMT may be useful for early detection of patients at high risk for cardiac dysfunction in the post-transplantation period.