title: Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma.
abstract: OBJECTIVE
  Phaeochromocytomas and paragangliomas (PPGL) can cause acute catecholamine cardiomyopathy (ACC). We assessed the prevalence of ACC and compared the presentation of cases with and without ACC in a large series of PPGL.
  
  
  METHODS
  Single centre retrospective study.
  
  
  METHODS
  Hypertension Unit, University Hospital, Paris.
  
  
  METHODS
  140 consecutive patients with PPGL, referred from January 2003 to September 2012.
  
  
  METHODS
  Left ventricular ejection fraction (LVEF), perioperative mortality.
  
  
  RESULTS
  Fifteen patients (11%) had suffered an ACC, occurring in 14 cases before the diagnosis of PPGL. Precipitating factors were identified in 11 cases. Twelve patients presented with acute pulmonary oedema, including 10 with cardiogenic shock, requiring life support in eight cases. Seven patients (five with pulmonary oedema) presented with acute chest pain and cardiac dysfunction. Electrocardiographic abnormalities were present in 14 cases: ST segment elevation or pathological Q waves, ST segment depression, and/or diffuse T wave inversion. Six patients displayed classical (apical ballooning) or inverted (basal/mid ventricular stunning) takotsubo-like cardiomyopathy. Coronary arteries were always normal on angiography. In patients with ACC, median LVEF rose from 30% (IQR 23-33%) during ACC to 71% (50-72%) before surgery (n=11, p<0.001). Median LVEF before PPGL surgery was 65% (51-72%) and 65% (60-70%) in patients with and without a history of ACC, respectively (not significant).
  
  
  CONCLUSIONS
  PPGL may present as ACC in 11% of cases, excluding patients dying from undiagnosed tumours. Left ventricular dysfunction is usually reversible before surgery. PPGL should be suspected in patients with acute heart failure without evidence of valvular or coronary artery disease.
authors.affiliation: Hypertension Unit, Université Paris-Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris cedex 15, France.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giavarini
authors.forename: Antoine
authors.initials: A
authors.lastname: Chedid
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bobrie
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Plouin
authors.forename: Albert
authors.initials: A
authors.lastname: Hagège
authors.forename: Laurence
authors.initials: L
authors.lastname: Amar
mesh_terms: D000208:Acute Disease; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D002395:Catecholamines / Q000097:blood / Q000378:metabolism / Q000652:urine; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010236:Paraganglioma, Extra-Adrenal / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D010297:Paris; D010673:Pheochromocytoma / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002395:Catecholamines