title: Acute and Chronic Pheochromocytoma-Induced Cardiomyopathies: Different Prognoses?: A Systematic Analytical Review.
abstract: Pheochromocytoma and paraganglioma (PPG) are rare and late-diagnosed catecholamine secreting tumors, which may be associated with unrecognized and/or severe cardiomyopathies. We performed a computer-assisted systematic search of the electronic Medline databases using the MESH terms "myocarditis," "myocardial infarction," "Takotsubo," "stress cardiomyopathy," "cardiogenic shock", or "dilated cardiomyopathy," and "pheochromocytoma" or "paraganglioma" from 1961 to August 2012. All detailed case reports of cardiomyopathy due to a PPG, without coronary stenosis, and revealed by acute symptoms were included and analyzed. A total of 145 cases reports were collected (49 Takotsubo Cardiomyopathies [TTC] and 96 other Catecholamine Cardiomyopathies [CC]). At initial presentation, prevalence of high blood pressure (87.7%), chest pain (49.0%), headaches (47.6%), palpitations (46.9%), sweating (39.3%), and shock (51.0%) were comparable between CC and TTC. Acute pulmonary edema (58.3% vs 38.8%, P = 0.03) was more frequent in CC. There was no difference in proportion of patients with severe left ventricular systolic dysfunction (LV Ejection Fraction [LVEF] < 30%) at initial presentation between both groups (P = 0.15). LVEF recovery before (64.9% vs 40.8%, P = 0.005) and after surgical resection (97.7% vs 73.3%, P = 0.001) was higher in the TTC group. Death occurred in 11 cases (7.6%). In multivariate analysis, only TTC was associated with a better LV recovery (0.15 [0.03-0.67], P = 0.03). Pheochromocytoma and paraganglioma can lead to different cardiomyopathies with the same brutal and life-threatening initial clinical presentation but with a different recovery rate. Diagnosis of unexplained dilated cardiomyopathy or TTC should lead clinicians to a specific search for PPG.
authors.affiliation: From the CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France (MB-L, CB, SM, BR, FD, IT); CNRS UMR 6293, Inserm GReD, Clermont-Ferrand, France (MB-L, SM, IT); CHU Clermont-Ferrand, Biostatistics unit (Clinical Research and Innovation Direction), Clermont-Ferrand, France (BP); and Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France (PM, RP, CV, GC, BC, J-RL, RE).
authors.forename: Marie
authors.initials: M
authors.lastname: Batisse-Lignier
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.forename: Romain
authors.initials: R
authors.lastname: Pierrard
authors.forename: Christelle
authors.initials: C
authors.lastname: Burnot
authors.forename: Charles
authors.initials: C
authors.lastname: Vorilhon
authors.forename: Salwan
authors.initials: S
authors.lastname: Maqdasy
authors.forename: Béatrice
authors.initials: B
authors.lastname: Roche
authors.forename: Francoise
authors.initials: F
authors.lastname: Desbiez
authors.forename: Guillaume
authors.initials: G
authors.lastname: Clerfond
authors.forename: Bernard
authors.initials: B
authors.lastname: Citron
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Lusson
authors.forename: Igor
authors.initials: I
authors.lastname: Tauveron
authors.forename: Romain
authors.initials: R
authors.lastname: Eschalier
mesh_terms: D000208:Acute Disease; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000473:pathology; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology*; D002908:Chronic Disease; D006801:Humans; D010673:Pheochromocytoma / Q000150:complications* / Q000473:pathology; D011379:Prognosis