Echocardiographic and biochemical evaluation of the development and progression of carcinoid heart disease.
OBJECTIVE
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.
Division of Cardiology, Vanderbilt University, Nashville, Tennessee, USA.
W D
WD
Denney
W E
WE
Kemp
L B
LB
Anthony
J A
JA
Oates
B F
BF
Byrd
D000328:Adult; D000368:Aged; D002275:Carcinoid Heart Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000652:urine; D018450:Disease Progression; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000000981:diagnostic imaging; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D014261:Tricuspid Valve / Q000000981:diagnostic imaging
D013004:Somatostatin; D006897:Hydroxyindoleacetic Acid