title: Assessment of patent foramen ovale in carcinoid heart disease.
abstract: OBJECTIVE
  Carcinoid syndrome may involve right carcinoid heart disease (CHD), secondary to the release of vasoactive substances. Left CHD is rare, as the inactivation of serotonin by the lung protects the left heart. We attempted to evaluate the prevalence of CHD and patent foramen ovale (PFO) with serial contrast transthoracic echocardiographic studies and to determine the markers of right and left CHD progression.
  
  
  METHODS
  Forty-one consecutive patients with proved digestive endocrine tumor and carcinoid syndrome were prospectively enrolled. All patients underwent serial conventional and contrast transthoracic echocardiographic studies. Right and left CHD, PFO, radiological examinations, and biological carcinoid markers were systematically assessed.
  
  
  RESULTS
  Left CHD was present in 5 patients at baseline and in 13 patients (32%) during follow-up (P = .03). The 13 patients with left CHD also had PFO, and no left CHD occurred without PFO (P < .0001). Right CHD was present in 16 patients (39%) at baseline and in 25 patients (61%) at the end of follow-up (P = .04). The prevalence of right and left CHD was significantly higher in patients with PFO (88% and 76%, respectively; P < .04). A progression of right and left CHD was present, respectively, in 19 and 9 patients but was mainly found in patients with PFO (15 and 9 patients; P < .0001). The main marker of CHD progression was the presence of PFO (odds ratio 44.2, 95% confidence interval 4.4-447.7; P = .001).
  
  
  CONCLUSIONS
  PFO is a new marker of CHD progression and should be systematically assessed with routine contrast transthoracic echocardiography in patients with carcinoid syndrome to determine patients at high risk of CHD progression.
authors.affiliation: Department of Cardiology, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne, France. nicolas.mansencal@apr.ap-hop-paris.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mansencal
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mitry
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Forissier
authors.forename: Fabrice
authors.initials: F
authors.lastname: Martin
authors.forename: Alban
authors.initials: A
authors.lastname: Redheuil
authors.forename: Céline
authors.initials: C
authors.lastname: Lepère
authors.forename: Jean-Christian
authors.initials: JC
authors.lastname: Farcot
authors.forename: Thierry
authors.initials: T
authors.lastname: Joseph
authors.forename: Pascal
authors.initials: P
authors.lastname: Lacombe
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
mesh_terms: D000328:Adult; D000368:Aged; D002275:Carcinoid Heart Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies