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The utility of cardiac biomarkers for identifying the risk of future cardiomyopathy and mortality is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>N\u2010terminal pro\u2013B\u2010type natriuretic peptide (NT\u2010proBNP) 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\u2010directed radiation therapy (RT). NT\u2010proBNP values above age\u2010 and sex\u2010specific 97.5th percentiles were considered abnormal. Generalized linear models estimated cross\u2010sectional associations between abnormal NT\u2010proBNP 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At a median age of 35.5 years (interquartile range, 29.8\u201042.5 years), NT\u2010proBNP 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\u2010dependent increased risk for abnormal NT\u2010proBNP (<jats:italic>P<\/jats:italic> for trend &lt;.0001). Among exposed survivors with no history of Common Terminology Criteria for Adverse Events\u2013graded cardiomyopathy and with normal systolic function, survivors with abnormal NT\u2010proBNP had higher rates per 1000 person\u2010years of cardiac mortality (2.93 vs 0.96; <jats:italic>P<\/jats:italic> &lt; .0001) and future cardiomyopathy (32.10 vs 15.98; <jats:italic>P<\/jats:italic> &lt; .0001) and an increased risk of future cardiomyopathy (HR, 2.28; 95% CI, 1.28\u20104.08) according to a multivariable assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Abnormal NT\u2010proBNP 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33292","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T13:31:06Z","timestamp":1603805466000},"page":"458-466","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Cardiac biomarkers and association with subsequent cardiomyopathy and mortality among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3901-3274","authenticated-orcid":false,"given":"Stephanie B.","family":"Dixon","sequence":"first","affiliation":[{"name":"Department of Oncology St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie R.","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of 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Institute University of Tennessee Health Science Center Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5156-5410","authenticated-orcid":false,"given":"Daniel M.","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Oncology St. Jude Children's Research Hospital Memphis Tennessee"},{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2781-9983","authenticated-orcid":false,"given":"Matthew J.","family":"Ehrhardt","sequence":"additional","affiliation":[{"name":"Department of Oncology St. Jude Children's Research Hospital Memphis Tennessee"},{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel 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