title: Cardiovascular dysfunction and catecholamine cardiomyopathy in pheochromocytoma patients and their reversal following surgical cure: results of a prospective case-control study.
abstract: BACKGROUND
  Cardiovascular (CV) dysfunction and cardiomyopathy can cause perioperative morbidity in pheochromocytoma patients, but have not been studied systematically. This prospective, case-control study evaluated nature and extent of CV dysfunctions and their reversal following curative pheochromocytoma surgery.
  
  
  METHODS
  Thirty-five pheochromocytoma patients, 9 normotensive nonpheochromocytoma adrenal tumors and 10 essential hypertensives were evaluated with 2-dimensional echocardiography, tissue Doppler, and serum N-terminal pro-brain natriuretic peptide (s-NTpro-BNP, a sensitive myocardial damage biomarker) serially before and after treatment.
  
  
  RESULTS
  Pheochromocytoma patients had systolic and diastolic dysfunction, reduced left ventricular (LV) ejection fraction (EF), increased LV end-diastolic and systolic dimensions and volumes, myocardial performance index, and decreased transmitral early/late velocity ratio, which were worse compared with controls. All indices improved significantly with α-blockade and after pheochromocytoma resection, and normalized over 3-6 months. Tissue Doppler early velocity was lower (P = .04) and s-NT-proBNP higher (P = .0001) in pheochromocytoma patients compared with controls. Seven pheochromocytoma patients (20%) had significant LV dysfunction (LVEF <45%; s-NTpro-BNP levels >500 pg/mL) and had more marked postoperative improvement.
  
  
  CONCLUSIONS
  Global LV diastolic and systolic dysfunctions specific to pheochromocytoma are common and improve early postoperatively, with sustained improvement upon follow-up. Detailed cardiac evaluation with echocardiography, tissue Doppler, and s-NTpro-BNP may help to reduce perioperative morbidity and monitor recovery in pheochromocytoma patients.
authors.affiliation: Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. gaurav@sgpgi.ac.in
authors.forename: Gaurav
authors.initials: G
authors.lastname: Agarwal
authors.forename: Dhalapathy
authors.initials: D
authors.lastname: Sadacharan
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.forename: Aditya
authors.initials: A
authors.lastname: Batra
authors.forename: Preeti
authors.initials: P
authors.lastname: Dabadghao
authors.forename: Gyan
authors.initials: G
authors.lastname: Chand
authors.forename: Anjali
authors.initials: A
authors.lastname: Mishra
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Verma
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Mishra
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery*; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D016022:Case-Control Studies; D002648:Child; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult