Progression of Carcinoid Heart Disease in the Modern Management Era

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Emilie Baron¹  Olivier Dubourg¹  Hélène Hergault¹  Marie Hauguel‐Moreau¹  Catherine Szymanski¹  Nicolas Mansencal¹  Céline Lepère² 

[1] Department of Cardiology Ambroise Paré HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou raresUniversité de Versailles‐Saint Quentin (UVSQ) Boulogne France;Department of Gastroenterology and Digestive Oncology European Georges Pompidou HospitalAP‐HP Paris France;

关键词: carcinoid heart disease;    valvular heart disease;    tricuspid regurgitation;    digestive endocrine tumor;   

DOI  :  10.1161/JAHA.120.020475

来源: DOAJ

【 摘 要 】

Background The development of carcinoid heart disease (CaHD) is still relatively unclear. It is difficult to define an optimal follow‐up for patients without any cardiac involvement at baseline. The aim of this study was to assess the prevalence and natural history of CaHD by annual echocardiographic examinations. Methods and Results We studied 137 consecutive patients (61±12 years, 53% men) with proven digestive endocrine tumor and carcinoid syndrome between 1997 and 2017. All patients underwent serial conventional transthoracic echocardiographic studies. Right‐sided and left‐sided CaHD were systematically assessed. We used a previous validated echocardiographic scoring system of severity for the assessment of CaHD. An increase of 25% of the score was considered to be significant. Mean follow‐up was 54±45 months. Prevalence of CaHD was 27% at baseline and 32% at 5‐year follow‐up. Disease progression was reported in 28% of patients with initial CaHD followed up for >2 years (n=25). In patients without any cardiac involvement at baseline, occurrence of disease was 21%. CaHD occurred >5 years from the initial echocardiographic examination in 42% of our cases, especially in patients presenting with new recurrence of a digestive endocrine tumor. An increase of urinary 5‐hydroxyindoleacetic acid by 25% during follow‐up was identified as an independent predictor of CaHD occurrence during follow‐up (hazard ratio [HR], 5.81; 95% CI, 1.19–28.38; P=0.03), as well as a maximum value of urinary 5‐hydroxyindoleacetic acid >205 mg/24 h during follow‐up (HR, 8.41; 95% CI, 1.64–43.07; P=0.01). Conclusions Our study demonstrates that in patients without initial CaHD, cardiac involvement may occur late and is related to serotonin. Our data emphasize the need for cardiologic follow‐up in patients with recurrence of the tumor process.

【 授权许可】

Unknown