The association of a panel of biomarkers with the presence and severity of carcinoid heart disease: a cross-sectional study.
OBJECTIVE
Metastatic neuroendocrine tumors secrete serotonin and other vasoactive substances that are responsible for carcinoid syndrome and carcinoid heart disease. We sought to evaluate the discriminatory utility of diagnostic biomarkers in determining the presence and severity of carcinoid heart disease in patients with metastatic neuroendocrine tumors.


METHODS
A cross-sectional study of patients with neuroendocrine tumors with documented liver metastases and/or carcinoid syndrome between April 2009-October 2012 in 5 tertiary referral centers. Serum was analyzed for Chromogranin A, Chromogranin B and N-terminal pro Brain Natriuretic Peptide (NT-proBNP). Plasma was analyzed for Neurokinin A and 5-Hydroxyindoleacetic acid (5HIAA). Echocardiography was used to determine the presence and severity of carcinoid heart disease. Non-parametric receiver operating characteristic curves were constructed for biomarkers, and the area under the curve determined. The severity of cardiac involvement was correlated with the concentration of each biomarker.


RESULTS
A total of 187 patients were identified of whom 37 (20%) had carcinoid heart disease. Significantly higher median values of all biomarkers were found in the patients with cardiac involvement. NT-proBNP and plasma 5HIAA had the highest areas under the curve for the prediction of carcinoid heart disease [NT-proBNP 0.82 (95% confidence interval 0.74-0.90, p<0.0001) and 5HIAA 0.85 (95% confidence interval 0.78-0.92, p<0.0001]. NT-proBNP was moderately correlated (r = 0.48, p<0.001) whereas plasma 5HIAA was only weakly correlated (r = 0.34, p<0.001) with the echocardiographic severity score.


CONCLUSIONS
NT-proBNP and plasma 5HIAA are both sensitive and specific biomarkers for the presence of carcinoid heart disease whereas only NT-proBNP is moderately correlated with disease severity.
Neuroendocrine Tumour Group, University Hospital Aintree, Liverpool, Merseyside, United Kingdom ; Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool Merseyside, United Kingdom.
Rebecca
R
Dobson
Malcolm I
MI
Burgess
Melissa
M
Banks
D Mark
DM
Pritchard
Jiten
J
Vora
Juan W
JW
Valle
Christopher
C
Wong
Carrie
C
Chadwick
Keith
K
George
Brian
B
Keevil
Joanne
J
Adaway
Joy E S
JE
Ardill
Alan
A
Anthoney
Uschi
U
Hofmann
Graeme J
GJ
Poston
Daniel J
DJ
Cuthbertson
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002275:Carcinoid Heart Disease / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D015288:Neurokinin A / Q000097:blood
D015415:Biomarkers; D006897:Hydroxyindoleacetic Acid; D015288:Neurokinin A