Echocardiographic and biochemical evaluation of the development and progression of carcinoid heart disease.

Denney WD, Kemp WE, Anthony LB, Oates JA, Byrd BF
J Am Coll Cardiol. 1998 32 (4): 1017-22

PMID: 9768727 · DOI:10.1016/s0735-1097(98)00354-4

OBJECTIVES - To study the applicability of a newly developed echocardiographic scoring system in the assessment of carcinoid valvular heart disease.

BACKGROUND - We investigated prospectively the development, progression and regression of carcinoid valvular heart disease in patients with carcinoid syndrome by serial echocardiography, correlating these features with urinary 5-HIAA levels and clinical data collected during therapy with somatostatin analog.

METHODS - Twenty-three patients with carcinoid syndrome underwent serial echocardiographic examinations. An echocardiographic carcinoid valvular heart disease (CVHD) % score was determined from points assigned for tricuspid and pulmonary valve structure and function.

RESULTS - Fifteen patients had no CVHD at study entry (group 1), while 8 patients had findings of CVHD (group 2). Five patients in group q developed new CVHD (1B), while one demonstrated progression of CVHD (2B). The remaining patients did not develop (1A) or had no progression of CVHD (2B). Despite major declines in 5-HIAA levels during therapy in most patients, CVHD did not regress. There were significantly lower levels of median baseline 5-HIAA (98.8 vs. 256 mg/24 h), posttreatment 5-HIAA (50.3 vs. 324 mg/24 h) and posttreatment 5-HIAA time integral (37.3 vs. 192 g/24 h* days) in group A vs. B (p < 0.05). However, only posttreatment 5-HIAA levels independently predicted the development or progression of CVHD by multiple step-wise regression analysis (p < 0.005), with a threshold observed in the 100 mg/24 h range.

CONCLUSIONS - We designed a new echocardiographic scoring system to evaluate CVHD. Correlating echocardiographic scores with biochemical and clinical markers showed that only posttreatment 5-HIAA levels independently predicted the development or progression of CVHD. This study strengthens the association between serotonin secretion and CVHD, as well as introducing a new technique for serial follow-up of these patients.

MeSH Terms (15)

Adult Aged Carcinoid Heart Disease Disease Progression Echocardiography Echocardiography, Doppler Female Humans Hydroxyindoleacetic Acid Male Middle Aged Prospective Studies Pulmonary Valve Somatostatin Tricuspid Valve

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