Cardiac manifestations in mid-gut carcinoid disease.
The extent of heart disease and its relationship to the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), was studied with M-mode, 2D and Doppler echocardiography in 42 consecutive patients, 30 females and 12 males, median age 63 (range 23-75) years with histologically verified mid-gut tumour, liver metastases and 24-h urinary 5-HIAA excretion above 47 mumol.24 h-1. All patients had normal left ventricular ejection fractions, median 65% (interquartile range (IQR) 54-74%). Moderate to severe tricuspid regurgitation (TR) was diagnosed in 22 patients (59%); mitral or aortic regurgitation was found in nine (24%) and six (16%) patients, respectively. The mitral flow peak early (E) on late (A) velocity ratio was significantly decreased compared to age-matched normal subjects. The group of patients with 5-HIAA excretion exceeding 1000 mumol.24h-1 contained significantly more patients with severe TR than those with a lower excretion. The decrease in the E/A ratio may indicate reduced left ventricular compliance, possibly secondary to fibrous changes similar to those seen intra-abdominally and in the right side of the heart. As serotonin is degraded in the lung circulation, other mediators such as tachykinins and cytokines (PDGF) may be involved.
Jacobsen
M B
MB
Medical Department A, Rikshospitalet, University of Oslo, Norway.
Nitter-Hauge
S
S
Bryde
P E
PE
Hanssen
L E
LE
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D002276:Carcinoid Tumor / Q000150:complications / Q000000981:diagnostic imaging / Q000652:urine*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000652:urine*; D007414:Intestinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
D006897:Hydroxyindoleacetic Acid