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Previous Volume 348:1005-1015 March 13, 2003 Number 11 Next

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ABSTRACT

Background By releasing vasoactive substances into the circulation, carcinoid tumors can cause right-sided valvular heart disease. Factors associated with the progression of carcinoid heart disease are poorly understood. We conducted a retrospective study to identify such factors.

Methods Our sample included 71 patients with the carcinoid syndrome who underwent serial echocardiographic studies performed more than one year apart and 32 patients referred directly for surgical intervention after an initial echocardiographic evaluation. A score for carcinoid heart disease was determined on the basis of an assessment of valvular anatomy and function and the function of the right ventricle. An increase of more than 25 percent in the score between studies was considered suggestive of disease progression. Tumor progression was assessed on the basis of abdominal computed tomographic scans and changes in the level of urinary 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of serotonin.

Results Of the patients with serial echocardiographic studies, 25 (35 percent) had an increase of more than 25 percent in the cardiac score. As compared with patients whose score changed by 25 percent or less, these patients had higher urinary peak 5-HIAA levels (median, 265 mg per 24 hours [interquartile range, 209 to 593] vs. 189 mg per 24 hours [interquartile range, 75 to 286]; P=0.004) and were more likely to have biochemical progression (10 of 25 patients vs. 9 of 46, P=0.05) and to have received chemotherapy (13 of 25 vs. 10 of 46, P=0.009). Logistic-regression analysis showed that a higher peak urinary 5-HIAA level and previous chemotherapy were predictors of an increase in the cardiac score that exceeded 25 percent (odds ratio for each increase in 5-HIAA of 25 mg per 24 hours, 1.08 [95 percent confidence interval, 1.03 to 1.13]; P=0.009); odds ratio associated with chemotherapy, 3.65 [95 percent confidence interval, 1.74 to 7.48]; P=0.001).

Conclusions Serotonin is related to the progression of carcinoid heart disease, and the risk of progressive heart disease is higher in patients who receive chemotherapy than in those who do not.

Source Information

From the Divisions of Cardiovascular Diseases (J.E.M., H.M.C., J.B.S., K.M., P.A.P.) and Medical Oncology (J.R.), Mayo Clinic, Rochester, Minn.

Address reprint requests to Dr. Pellikka at the Echocardiography Laboratory, Gonda 6-138 NW, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, or at pellikka.patricia{at}mayo.edu.

Full Text of this Article

Related Letters:

Carcinoid Heart Disease
van der Horst-Schrivers A. N.A., Wymenga A. N.M., de Vries E. G.D., Zuetenhorst J. M., Taal B. G., Møller J. E., Connolly H. M., Pellikka P. A.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:2359-2361, Jun 5, 2003. Correspondence

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