{"doi":"10.1002/cncr.33292","title":"Cardiac biomarkers and association with subsequent cardiomyopathy and mortality among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort","abstract":"BACKGROUND: Survivors of childhood cancer exposed to cardiotoxic therapies are at significant cardiovascular risk. The utility of cardiac biomarkers for identifying the risk of future cardiomyopathy and mortality is unknown. METHODS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) were assessed in 1213 adults 10 or more years from a childhood cancer diagnosis; 786 were exposed to anthracycline chemotherapy and/or chest-directed radiation therapy (RT). NT-proBNP values above age- and sex-specific 97.5th percentiles were considered abnormal. Generalized linear models estimated cross-sectional associations between abnormal NT-proBNP and anthracycline or chest RT doses as risk ratios with 95% confidence intervals (CIs). A Poisson distribution estimated rates and a Cox proportional hazards model estimated hazard ratios (HRs) for future cardiac events and death. RESULTS: At a median age of 35.5 years (interquartile range, 29.8-42.5 years), NT-proBNP and cTnT were abnormal in 22.5% and 0.4%, respectively. Exposure to chest RT and exposure to anthracycline chemotherapy were each associated with a dose-dependent increased risk for abnormal NT-proBNP (P for trend <.0001). Among exposed survivors with no history of Common Terminology Criteria for Adverse Events-graded cardiomyopathy and with normal systolic function, survivors with abnormal NT-proBNP had higher rates per 1000 person-years of cardiac mortality (2.93 vs 0.96; P < .0001) and future cardiomyopathy (32.10 vs 15.98; P < .0001) and an increased risk of future cardiomyopathy (HR, 2.28; 95% CI, 1.28-4.08) according to a multivariable assessment. CONCLUSIONS: Abnormal NT-proBNP values were prevalent and, among survivors who were exposed to cardiotoxic therapy but did not have a history of cardiomyopathy or current systolic dysfunction, identified those at increased risk for future cardiomyopathy. Further longitudinal studies are needed to confirm this novel finding.","journal":"Cancer","year":2020,"id":95566,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":36,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9155,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":255610,"name":"Carrie R. Howell","orcid":"0000-0002-6554-6237","position":1,"is_corresponding":false},{"id":237956,"name":"Lu Lu","orcid":"0000-0002-2255-0391","position":2,"is_corresponding":false},{"id":475975,"name":"Juan Carlos Plana","orcid":null,"position":3,"is_corresponding":false},{"id":474828,"name":"Vijaya M. Joshi","orcid":"0000-0001-6744-1378","position":4,"is_corresponding":false},{"id":428408,"name":"Russell V. Luepker","orcid":"0000-0003-1910-9543","position":5,"is_corresponding":false},{"id":475976,"name":"Jean Bernard Durand","orcid":null,"position":6,"is_corresponding":false},{"id":282965,"name":"Bonnie Ky","orcid":"0000-0002-6628-9981","position":7,"is_corresponding":false},{"id":474829,"name":"Daniel J. Lenihan","orcid":"0000-0001-9458-0154","position":8,"is_corresponding":false},{"id":255619,"name":"John L. Jefferies","orcid":"0000-0002-4046-2352","position":9,"is_corresponding":false},{"id":255617,"name":"Daniel M. Green","orcid":"0000-0002-5156-5410","position":10,"is_corresponding":false},{"id":255631,"name":"Matthew J. Ehrhardt","orcid":"0000-0003-2781-9983","position":11,"is_corresponding":false},{"id":255621,"name":"Daniel A. Mulrooney","orcid":"0000-0003-2351-9115","position":12,"is_corresponding":false},{"id":475977,"name":"Timothy E. Folse","orcid":null,"position":13,"is_corresponding":false},{"id":474830,"name":"Robyn E. Partin","orcid":"0000-0003-0410-8951","position":14,"is_corresponding":false},{"id":475978,"name":"Aimee Santucci","orcid":null,"position":15,"is_corresponding":false},{"id":310246,"name":"Rebecca M. Howell","orcid":"0000-0002-0803-071X","position":16,"is_corresponding":false},{"id":255625,"name":"Deo Kumar Srivastava","orcid":"0000-0001-6693-8120","position":17,"is_corresponding":false},{"id":255630,"name":"Melissa M. Hudson","orcid":"0000-0001-6984-2407","position":18,"is_corresponding":false},{"id":230935,"name":"Leslie L. Robison","orcid":"0000-0001-7460-8578","position":19,"is_corresponding":false},{"id":255612,"name":"Kirsten K. Ness","orcid":"0000-0002-2084-1507","position":20,"is_corresponding":false},{"id":230934,"name":"Gregory T. Armstrong","orcid":"0000-0001-8722-4207","position":21,"is_corresponding":false},{"id":474827,"name":"Stephanie B. Dixon","orcid":"0000-0003-3901-3274","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-18T22:33:57.534608Z","pmid":"33108003","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}