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Cuspidi C, Gherbesi E, Faggiano A, Sala C, Carugo S, Grassi G, Tadic M. Targeting Left Ventricular Mechanics In Patients With Pheochromocytoma/Paraganglioma: An Updated Meta-analysis. Am J Hypertens 2023; 36:333-340. [PMID: 36617865 PMCID: PMC10413314 DOI: 10.1093/ajh/hpad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/17/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Numerous studies targeting left ventricular (LV) systolic function by measuring LV ejection fraction (LVEF) in patients with pheochromocytoma and paraganglioma (PPGL) either failed to reveal any impairment of this parameter or found a super-normal systolic function compared to essential hypertensives or normotensive controls. To provide an updated piece of information on LV systolic dysfunction in the PPGL setting, we performed a meta-analysis of speckle tracking echocardiography (STE) studies investigating LV mechanics via global longitudinal strain (GLS), a more sensitive index of LV systolic function than LVEF. METHODS A computerized search was performed using PubMed, OVID, EMBASE, and Cochrane library databases from inception until September 30, 2022. Full articles reporting data on LV GLS and LVEF in patients with PPGL and controls were considered suitable. RESULTS A total of 252 patients with PPGL and 187 controls were included in 6 studies. LV GLS was worse in the pooled PPGL group than in the control group (-17.3 ± 1.2 vs. -20.0 ± 0.6) with a standard means difference (SMD) of 1.13 ± 0.36 confidence interval (CI: 0.43-1.84, P = 0.002), whereas this was not the case for LVEF (67.3 ± 1.9 and 66.4 ± 1.6%, respectively), SMD: 0.12 ± 0.03, (CI: -0.41/0.65, P = 0.66). A meta-regression analysis in PPGL patients showed an inverse relationship between adrenergic activity and GLS (P < 0.0001). CONCLUSIONS Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the PPGL setting can be revealed by STE; therefore, STE implementation in the workup of patients with PPGL may improve the detection of subclinical systolic dysfunction.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, University Hospital “Dr.DragisaMisovic-Dedinje”, HerojaMilanaTepica 1,11000Belgrade, Serbia
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Macedo TA, Drager LF, Vieira MLC. What is the effect of catecholamines on diastolic function in patients with pheochromocytoma and paraganglioma? JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:36-37. [PMID: 36468283 DOI: 10.1002/jcu.23295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/17/2023]
Abstract
Pheochromocytoma is a rare form of secondary hypertension characterized by excessive production of catecholamines typically due to a benign tumor in the adrenal medulla. Among the potential cardiac repercussions of pheochromocytoma and paraganglioma, previous studies described echocardiographic abnormalities such as dynamic left ventricular outflow tract obstruction (i), cardiomyopathy (ii, iii, iv), reversible dilatation of the left ventricle (v) and left ventricular functional changes (vi) in patients with pheochromocytoma.
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Affiliation(s)
- Thiago Andrade Macedo
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Luciano F Drager
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
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Januszewicz A, Mulatero P, Dobrowolski P, Monticone S, Van der Niepen P, Sarafidis P, Reincke M, Rexhaj E, Eisenhofer G, Januszewicz M, Kasiakogias A, Kreutz R, Lenders JW, Muiesan ML, Persu A, Agabiti-Rosei E, Soria R, Śpiewak M, Prejbisz A, Messerli FH. Cardiac Phenotypes in Secondary Hypertension. J Am Coll Cardiol 2022; 80:1480-1497. [DOI: 10.1016/j.jacc.2022.08.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
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Lan L, Shu Q, Yu C, Pei L, Zhang Y, Xu L, Huang Y. Incidence and risk factors for myocardial injury after laparoscopic adrenalectomy for pheochromocytoma: A retrospective cohort study. Front Oncol 2022; 12:979994. [PMID: 36172145 PMCID: PMC9511041 DOI: 10.3389/fonc.2022.979994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPheochromocytoma is a rare catecholamine-secreting tumor. Tumor resection remains a high-risk procedure due to intraoperative hemodynamic instability nowadays, which may lead to myocardial injury. We aimed to determine the incidence and associated risk factors for myocardial injury after laparoscopic adrenalectomy for pheochromocytoma.MethodsAdult patients (n=350, American Society of Anesthesiology physical status 1–3) who underwent elective laparoscopic adrenalectomy for pheochromocytoma under general anesthesia between January 31, 2013 and January 31, 2020 were included in this observational, retrospective, single-center, cohort study. Blood troponin I levels were measured before and during the first 2 days after surgery. Myocardial injury was defined as an elevated troponin I level exceeding the 99th percentile upper reference limit due to cardiac ischemic causes.ResultsMyocardial injury occurred in 42/350 patients (12.0%, 95% confidence interval: 9.0%–15.9%). In multivariable analysis (adjusted odds ratios [95% confidence intervals]), previous ischemic heart disease or stroke (5.04 [1.40–18.08]; P=0.013), intraoperative heart rate >115 bpm (2.55 [1.06–6.12]; P=0.036), intraoperative systolic blood pressure >210 mmHg (2.38 [1.00–5.66]; P=0.049), and perioperative decrease in hemoglobin level(1.74 [1.15–2.64] per g/dL decrease; P=0.008) were associated with an increased risk of myocardial injury. For the cumulative duration of dichotomized intraoperative hemodynamics, multivariable analysis showed that intraoperative heart rate >115 bpm for >1 minute (2.67 [1.08–6.60]; P=0.034) and systolic blood pressure >210 mmHg for >1 minute (3.78 [1.47–9.73]; P=0.006) were associated with an increased risk of myocardial injury. The risk of myocardial injury progressively increased with a longer cumulative duration of intraoperative tachycardia and hypertension.ConclusionsThere is a high incidence of myocardial injury after laparoscopic adrenalectomy for pheochromocytoma. The identified risk factors may assist physicians in detecting high-risk patients and providing guidance for intraoperative hemodynamics and perioperative hemoglobin management.
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Affiliation(s)
- Ling Lan
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qian Shu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lijian Pei
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Li Xu, ; Yuguang Huang,
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Li Xu, ; Yuguang Huang,
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