Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease.
Carcinoid heart disease (CHD) occurs in 20-70% of the patients with metastatic well-differentiated neuroendocrine tumours (NET). We evaluated whether natriuretic peptides (ANP or NT-proBNP) are useful in early detection of CHD. Blood samples from 32 patients with NET were compared with cardiac ultrasound follow-up. CHD was defined as thickening of the tricuspid valve in the presence of grade III-IV/IV tricuspid valve regurgitation. CHD was found in nine out of 32 patients (28%), all with symptoms of the carcinoid syndrome compared to 65% in the 23 patients without CHD (P=0.04). Median levels of NT-proBNP and 5-HIAA were significantly higher in patients with CHD (894 ng l(-1) and 815 micromol 24 h(-1)) compared to those without (89 and 206 ng l(-1), P<0.001 and P=0.007). No significant differences were detected in ANP levels (P=0.11). Dilatation of the right atrium and ventricle as well as thickening of the tricuspid valve and degree of regurgitation were statistically significant correlated with NT-proBNP levels. The accuracy of NT-proBNP in the diagnosis of CHD was higher than that of ANP. A significantly better survival was observed in case of normal NT-proBNP values. In conclusion, NT-proBNP is helpful as a simple marker in the diagnosis of CHD. Survival is better in patients with normal levels of NT-proBNP.
Zuetenhorst
J M
JM
Department of Gastroenterology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. j.zuetenhorst@nki.nl
Korse
C M
CM
Bonfrer
J M G
JM
Bakker
R H
RH
Taal
B G
BG
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D002275:Carcinoid Heart Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000032:analysis / Q000097:blood*; D011379:Prognosis; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014261:Tricuspid Valve / Q000473:pathology; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000473:pathology
D014408:Biomarkers, Tumor; D045265:Natriuretic Peptides