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Bulj N, Tomasic V, Cigrovski Berkovic M. Managing end-stage carcinoid heart disease: A case report and literature review. World J Gastrointest Oncol 2024; 16:1076-1083. [PMID: 38577438 PMCID: PMC10989396 DOI: 10.4251/wjgo.v16.i3.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/26/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare tumors, often diagnosed in an advanced stage when curative treatment is impossible and grueling symptoms related to vasoactive substance release by tumor cells affect patients' quality of life. Cardiovascular complications of GEP-NENs, primarily tricuspid and pulmonary valve disease, and right-sided heart failure, are the leading cause of death, even compared to metastatic disease. CASE SUMMARY We present a case of a 35-year-old patient with progressive dyspnea, back pain, polyneuropathic leg pain, and nocturnal diarrhea lasting for a decade before the diagnosis of neuroendocrine carcinoma of unknown primary with extensive liver metastases. During the initial presentation, serum biomarkers were not evaluated, and the patient received five cycles of doxorubicin, which he did not tolerate well, so he refused further therapy and was lost to follow-up. After 10 years, he presented to the emergency room with signs and symptoms of right-sided heart failure. Panneuroendocrine markers, serum chromogranin A, and urinary 5-hydroxyindoleacetic acid were extremely elevated (900 ng/mL and 2178 µmol/L), and transabdominal ultrasound confirmed hepatic metastases. Computed tomography (CT) showed liver metastases up to 6 cm in diameter and metastases in mesenteric lymph nodes and pelvis. Furthermore, an Octreoscan showed lesions in the heart, thoracic spine, duodenum, and ascendent colon. A standard transthoracic echocardiogram confirmed findings of carcinoid heart disease. The patient was not a candidate for valve replacement. He started octreotide acetate treatment, and the dose escalated to 80 mg IM monthly. Although biochemical response and symptomatic improvement were noted, the patient died. CONCLUSION Carcinoid heart disease occurs with carcinoid syndrome related to advanced neuroendocrine tumors, usually with liver metastases, which manifests as right-sided heart valve dysfunction leading to right-sided heart failure. Carcinoid heart disease and tumor burden are major prognostic factors of poor survival. Therefore, they must be actively sought by available biochemical markers and imaging techniques. Moreover, imaging techniques aiding tumor detection and staging, somatostatin receptor positron emission tomography/CT, and CT or magnetic resonance imaging, should be performed at the time of diagnosis and in 3- to 6-mo intervals to determine tumor growth rate and assess the possibility of locoregional therapy and/or palliative surgery. Valve replacement at the onset of symptoms or right ventricular dysfunction may be considered, while any delay can worsen right-sided ventricular failure.
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Affiliation(s)
- Nikola Bulj
- Department of Cardiology, University Hospital Centre “Sestre Milosrdnice,“ Zagreb 10000, Croatia
| | - Vedran Tomasic
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Centre “Sestre Milosrdnice,” Zagreb 10000, Croatia
| | - Maja Cigrovski Berkovic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology, Zagreb 10000, Croatia
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Costa IBSDS, Melo EDS, Furtado A, Sobral-Alves JB, Rizk SI, Benvenuti LA, Rochitte CE, Brandão CMDA, Pomarentzeff PM, Bittar CS, Galas FRBG, Auler JOC, Hoff PMG, Kalil R, Jatene FB, Hajjar LA. Carcinoid Heart Disease: A Case Report and Literature Review. Arq Bras Cardiol 2023; 120:e20220245. [PMID: 37466488 PMCID: PMC10365021 DOI: 10.36660/abc.20220245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 01/24/2023] [Accepted: 04/05/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Isabela Bispo Santos da Silva Costa
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP – Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP – Brasil
| | - Edielle de Sant`Anna Melo
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP – Brasil
| | - Armando Furtado
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Juliana Barbosa Sobral-Alves
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP – Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Stephanie Itala Rizk
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP – Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Luiz Alberto Benvenuti
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Carlos E. Rochitte
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Carlos Manuel de Almeida Brandão
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Pablo Maria Pomarentzeff
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Cristina Salvadori Bittar
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP – Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Filomena Regina Barbosa Gomes Galas
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP – Brasil
| | - José Otavio Costa Auler
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Paulo Marcelo Gehm Hoff
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP – Brasil
| | - Roberto Kalil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP – Brasil
| | - Fabio Biscegli Jatene
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Ludhmila Abrahão Hajjar
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP – Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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Grundmann E, Curioni-Fontecedro A, Christ E, Siebenhüner AR. Outcome of carcinoid heart syndrome in patients enrolled in the SwissNet cohort. BMC Cancer 2023; 23:338. [PMID: 37055717 PMCID: PMC10099832 DOI: 10.1186/s12885-023-10739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/14/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Carcinoid heart disease is a rare disease which develops in patients with functional neuroendocrine tumors in an advanced tumor state. Patients diagnosed with carcinoid heart disease have a poor longtime prognosis with respect to morbidity and mortality and long-term data on patient outcomes are lacking. METHODS AND RESULTS In this retrospective study, we analyzed outcomes of 23 patients with carcinoid heart disease enrolled into the SwissNet database. We observed that early diagnosis with echocardiographic surveillance of carcinoid heart disease during the course of the neuroendocrine tumor disease was beneficial to overall survival of patients. CONCLUSION Through nationwide patient enrollment, the SwissNet registry is a powerful data tool to identify, follow-up and evaluate long-term patient outcomes in patients with rare neuroendocrine tumor driven pathologies including carcinoid heart syndrome with observational methods enabling better therapy optimization to improve patient`s long-term perspectives and survival. In line with the current ESMO recommendations, our data proposes that heart echocardiography should be included as part of the general physical assessment in patients with newly diagnosed NET.
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Affiliation(s)
- Eva Grundmann
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland
| | - Alessandra Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland
| | - Emanuel Christ
- Department of Endocrinology, Diabetes, and Metabolism, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Alexander R Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland.
- Clinic of Medical Oncology and Hematology, Hirslanden Zurich AG, Witellikerstrasse 40, Zurich, CH-8032, Switzerland.
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Alvarez-Villegas D, Giménez-Milà M, Sbraga F, Camprubí I, Gil A. WITHDRAWN: Dealing With the Right Side: Carcinoid Heart Disease. J Cardiothorac Vasc Anesth 2022; 36:2228-2231. [PMID: 35337745 DOI: 10.1053/j.jvca.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 02/08/2022] [Indexed: 11/11/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in Journal of Cardiothoracic and Vascular Anesthesia, 36 (2022) 2793-2802, http://dx.doi.org/10.1053/j.jvca.2021.10.030. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- David Alvarez-Villegas
- Department of Anesthesia and Critical Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Giménez-Milà
- Department of Anesthesia and Critical Care, Hospital Clínic Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Fabrizio Sbraga
- Department of Cardiovascular Surgery and Transplantation, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Inmaculada Camprubí
- Department of Anesthesia and Critical Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Gil
- Department of Anesthesia and Critical Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Kostiainen I, Karppinen N, Simonen P, Rosengård-Bärlund M, Lindén R, Tarkkanen M, Gordin D, Rapola J, Schalin-Jäntti C, Matikainen N. Arterial function, biomarkers, carcinoid syndrome and carcinoid heart disease in patients with small intestinal neuroendocrine tumours. Endocrine 2022; 77:177-187. [PMID: 35536452 PMCID: PMC9242958 DOI: 10.1007/s12020-022-03065-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Carcinoid heart disease (CHD) is a life-threatening complication of carcinoid syndrome (CS) characterised by tricuspid regurgitation (TR). However, there is an unmet need for earlier diagnosis of CHD. We cross-sectionally assessed the prevalence and potential predictive or diagnostic markers for CS and CHD in a contemporary cohort of patients with small intestinal neuroendocrine tumours (SI-NETs). METHODS Biochemical characteristics, hepatic tumour load, measures of arterial and endothelial function, atherosclerosis, and transthoracic echocardiography were analysed in a prospective cross-sectional setting. RESULTS Among the 65 patients studied, 29 (45%) had CS (CS+ ), and 3 (5%) CHD. CS+ was characterised by significantly higher hepatic tumour load, S-5-HIAA and fP-CgA, higher frequency of diarrhoea and flushing, and more frequent PRRT compared to CS- (for all, P < 0.05). Central systolic, central mean, and central end-systolic blood pressures were significantly higher in CS+ than in CS- (for all, P < 0.05). Subjects with grades 2-4 TR had higher hepatic tumour burden, fP-CgA, and S-5-HIAA compared to those with grades 0-1 TR, but measures of vascular function did not differ. fP-CgA (P = 0.017) and S-5-HIAA (P = 0.019) but not proBNP increased significantly according to the severity of TR. CONCLUSION Although CS is common, the prevalence of CHD was found to be lower in a contemporary cohort of SI-NET patients than previously anticipated. Measures of arterial or endothelial function or carotid atherosclerosis do not identify subjects with mild TR. Echocardiography remains the most sensitive means to diagnose CHD in CS patients with high tumour burden and elevated CgA and 5-HIAA.
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Affiliation(s)
- Iiro Kostiainen
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Noora Karppinen
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Piia Simonen
- Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Milla Rosengård-Bärlund
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Riikka Lindén
- Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maija Tarkkanen
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Finnish Medicines Agency FIMEA, Helsinki, Finland
| | - Daniel Gordin
- Department of Nephrology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Minerva Institute for Medical Research, Helsinki, Finland
| | - Janne Rapola
- Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Niina Matikainen
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Vaideeswar P, Singaravel S, Butany J. Valvular heart disease. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Alvarez-Villegas D, Giménez-Milà M, Sbraga F, Camprubí I, Gil A, Valchanov K, Shayan H, Castillo J, Weiner MM. Dealing With the Right Side: Carcinoid Heart Disease. J Cardiothorac Vasc Anesth 2021; 36:2793-2802. [PMID: 34863651 DOI: 10.1053/j.jvca.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Affiliation(s)
- David Alvarez-Villegas
- Department of Anesthesia and Critical Care,Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Giménez-Milà
- Department of Anesthesia and Critical Care,Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | - Fabrizio Sbraga
- Department of Cardiovascular Surgery and Transplantation, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Immaculada Camprubí
- Department of Anesthesia and Critical Care,Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Gil
- Department of Anesthesia and Critical Care,Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Kamen Valchanov
- Department of Anesthesia,Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Hossain Shayan
- Department of Cardiac Surgery, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Javier Castillo
- Heart & Lung Institute, Bayamon Medical Center, Bayamon, Puerto Rico
| | - Menachem M Weiner
- Department of Anesthesiology, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY
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Kuo HF, Liu IF, Li CY, Tsai CS, Chen YH, Lian WS, Lin TC, Liu YR, Lee TY, Huang CY, Hsieh CC, Hsu CH, Lin FY, Liu PL. Endocardial Endothelial Dysfunction and Unknown Polymorphic Composite Accumulation in Heart Failure. Biomedicines 2021; 9:biomedicines9101465. [PMID: 34680582 PMCID: PMC8533412 DOI: 10.3390/biomedicines9101465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023] Open
Abstract
The accumulation of unknown polymorphic composites in the endocardium damages the endocardial endothelium (EE). However, the composition and role of unknown polymorphic composites in heart failure (HF) progression remain unclear. Here, we aimed to explore composite deposition during endocardium damage and HF progression. Adult male Sprague–Dawley rats were divided into two HF groups—angiotensin II-induced HF and left anterior descending artery ligation-induced HF. Heart tissues from patients who had undergone coronary artery bypass graft surgery (non-HF) and those with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) were collected. EE damage, polymorphic unknown composite accumulation, and elements in deposits were examined. HF progression reduced the expression of CD31 in the endocardium, impaired endocardial integrity, and exposed the myofibrils and mitochondria. The damaged endocardial surface showed the accumulation of unknown polymorphic composites. In the animal HF model, especially HF caused by myocardial infarction, the weight and atomic percentages of O, Na, and N in the deposited composites were significantly higher than those of the other groups. The deposited composites in the human HF heart section (DCM) had a significantly higher percentage of Na and S than the other groups, whereas the percentage of C and Na in the DCM and ICM groups was significantly higher than those of the control group. HF causes widespread EE dysfunction, and EndMT was accompanied by polymorphic composites of different shapes and elemental compositions, which further damage and deteriorate heart function.
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Affiliation(s)
- Hsuan-Fu Kuo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (H.-F.K.); (C.-Y.L.); (T.-C.L.)
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - I-Fan Liu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Heart Center, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Chia-Yang Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (H.-F.K.); (C.-Y.L.); (T.-C.L.)
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei 114, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan;
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
| | - Wei-Shiung Lian
- Core Laboratory for Phenomics and Diagnostic, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Tzu-Chieh Lin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (H.-F.K.); (C.-Y.L.); (T.-C.L.)
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Ru Liu
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-R.L.); (T.-Y.L.); (C.-Y.H.)
| | - Tsung-Ying Lee
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-R.L.); (T.-Y.L.); (C.-Y.H.)
| | - Chi-Yuan Huang
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-R.L.); (T.-Y.L.); (C.-Y.H.)
| | - Chong-Chao Hsieh
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (C.-C.H.); (C.-H.H.); (F.-Y.L.); (P.-L.L.)
| | - Chih-Hsin Hsu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 740, Taiwan
- Correspondence: (C.-C.H.); (C.-H.H.); (F.-Y.L.); (P.-L.L.)
| | - Feng-Yen Lin
- Department of Internal Medicine and Taipei Heart Institute, Taipei Medical University, Taipei 106, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 106, Taiwan
- Correspondence: (C.-C.H.); (C.-H.H.); (F.-Y.L.); (P.-L.L.)
| | - Po-Len Liu
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-R.L.); (T.-Y.L.); (C.-Y.H.)
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Correspondence: (C.-C.H.); (C.-H.H.); (F.-Y.L.); (P.-L.L.)
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Ebrahimi AJ, Marogil P, Von Mering G, Ahmed M. A clinical and echocardiographic case report of carcinoid-related valvular heart disease. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33442593 PMCID: PMC7793036 DOI: 10.1093/ehjcr/ytaa363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/17/2019] [Accepted: 09/10/2020] [Indexed: 11/13/2022]
Abstract
Background Carcinoid syndrome is a rare disease caused by malignant neuroendocrine neoplasms. When vasoactive substances enter the systemic circulation, the triad of cutaneous flushing, bronchospasm, and diarrhoea often characterize carcinoid syndrome. Rarely, carcinoid syndrome can progress to involve the cardiac system, a condition known as carcinoid heart disease, often affecting right-sided valvular structures. Case summary Here, we present a case of malignant carcinoid syndrome with associated carcinoid heart disease in a 63-year-old female. The diagnosis of her dual regurgitant and stenotic valvular disease is detailed, with accompanying two- and three-dimensional echocardiographic images demonstrating the patient’s complex tricuspid dysfunction. Discussion Carcinoid heart disease encompasses a rare but important subset of valvular dysfunction caused by circulating vasoactive substances. Diagnosis utilizing serum studies, computed tomography scans, and echocardiography can help expedite the diagnosis and treatment of such rare conditions, and assist in the avoidance of complications. Despite its relatively well-recognized clinical presentation, carcinoid syndrome and its associated heart disease still remains a challenging condition to manage and treat, often requiring the input of several subspecialties to treat the condition appropriately.
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Affiliation(s)
- Ali J. Ebrahimi
- Department of Cardiovascular disease, Northside Hospital/Tampa Bay Heart Institute, St. Petersburg , FL, USA
- Division of Cardiology, University of Alabama Birmingham , Birmingham, AL, USA
| | - Peter Marogil
- Division of Cardiology, Franciscan Health , Chicago, IL, USA
| | - Gregory Von Mering
- Division of Cardiology, University of Alabama Birmingham , Birmingham, AL, USA
| | - Mustafa Ahmed
- Division of Cardiology, University of Alabama Birmingham , Birmingham, AL, USA
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Bober B, Saracyn M, Kołodziej M, Kowalski Ł, Deptuła-Krawczyk E, Kapusta W, Kamiński G, Mozenska O, Bil J. Carcinoid Heart Disease: How to Diagnose and Treat in 2020? CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820968101. [PMID: 33192110 PMCID: PMC7597558 DOI: 10.1177/1179546820968101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 09/25/2020] [Indexed: 01/17/2023]
Abstract
Neuroendocrine tumors (NETs, originally termed “carcinoids”) create a relatively rare group of neoplasms with an approximate incidence rate of 2.5 to 5 cases per 100 000 persons. Roughly 30% to 40% of subjects with NETs develop carcinoid syndrome (CS), and 20% to 50% of subjects with CS are diagnosed with carcinoid heart disease (CaHD). The long-standing exposure to high serum serotonin concentration is one of the crucial factors in CaHD development. White plaque-like deposits on the endocardial surface of heart structures with valve leaflets and subvalvular apparatus thickening (fused and shortened chordae; thickened papillary muscles) are characteristic for CaHD. NT pro-BNP and 5-hydroxyindoleacetic acid are the 2 most useful screening markers. Long-acting somatostatin analogs are the standard of care in symptoms control. They are also the first-line treatment for tumor control in subjects with a metastatic somatostatin receptor avid disease. In cases refractory to somatostatin analogs, several options are available. We can increase a somatostatin analog to off-label doses, add telotristat ethyl or administer peptide receptor radionuclide therapy. Cardiac surgery, which mainly involves valve replacement, is presently the most efficient strategy in subjects with advanced CaHD and can relieve unmanageable symptoms or be partly responsible for better prognosis.
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Affiliation(s)
- Barbara Bober
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Mazowieckie, Poland
| | - Marek Saracyn
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Mazowieckie, Poland
| | - Maciej Kołodziej
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Mazowieckie, Poland
| | - Łukasz Kowalski
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Mazowieckie, Poland
| | - Elżbieta Deptuła-Krawczyk
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Mazowieckie, Poland
| | - Waldemar Kapusta
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Mazowieckie, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Mazowieckie, Poland
| | - Olga Mozenska
- Department of Internal Medicine, Hypertension and Vascular Diseases, Warsaw Medical University, Warsaw, Poland
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Jin C, Sharma AN, Thevakumar B, Majid M, Al Chalaby S, Takahashi N, Tanious A, Arockiam AD, Beri N, Amsterdam EA. Carcinoid Heart Disease: Pathophysiology, Pathology, Clinical Manifestations, and Management. Cardiology 2020; 146:65-73. [PMID: 33070143 DOI: 10.1159/000507847] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/05/2020] [Indexed: 11/19/2022]
Abstract
Carcinoid heart disease (CHD) is a rare and potentially lethal manifestation of an advanced carcinoid (neuroendocrine) tumor. The pathophysiology of CHD is related to vasoactive substances secreted by the tumor, of which serotonin is most prominent in the pathophysiology of CHD. Serotonin stimulates fibroblast growth and fibrogenesis, which can lead to cardiac valvular fibrosis. CHD primarily affects right heart valves, causing tricuspid and pulmonic regurgitation and less frequently stenosis of these valves. Left heart valves are usually spared because vasoactive substances such as serotonin are enzymatically inactivated in the lung vasculature. The pathology of CHD is characterized by plaque-like deposition of fibrous tissue on valvular cusps, leaflets, papillary muscles, chordae, and ventricular walls. Symptomatic CHD usually presents between 50 and 70 years of age, initially as dyspnea and fatigue. Echocardiography is the mainstay of imaging and demonstrates thickened right heart valves with limited mobility and regurgitation. Treatment focuses on control of the underlying carcinoid syndrome, targeting subsequent valvular heart disease and managing consequent heart failure. Surgical valve replacement and catheter-directed valve procedures may be effective for selected patients with CHD.
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Affiliation(s)
- Chengyue Jin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Ajay Nair Sharma
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Balasingam Thevakumar
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Muhammad Majid
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Shahad Al Chalaby
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Nene Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Ashraf Tanious
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Aro Daniela Arockiam
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Neil Beri
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA
| | - Ezra A Amsterdam
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California, USA,
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12
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Ram P, Penalver JL, Lo KBU, Rangaswami J, Pressman GS. Carcinoid Heart Disease: Review of Current Knowledge. Tex Heart Inst J 2019; 46:21-27. [PMID: 30833833 DOI: 10.14503/thij-17-6562] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Carcinoid heart disease is the collective term for all cardiac manifestations in patients who have carcinoid syndrome. Carcinoid heart disease has a multifactorial pathophysiology, and the right side of the heart is usually involved. Symptoms and signs vary depending upon the affected cardiac components; most typical is right-sided heart failure secondary to diseased tricuspid and pulmonary valves. Despite no single ideal diagnostic test, strong suspicion, coupled with serologic and imaging results, usually enables diagnosis. Advances in imaging, such as speckle-tracking echocardiography and cardiac magnetic resonance, have improved the diagnostic yield. Treatment is challenging, warrants a multidisciplinary approach, and can be medical or surgical depending on the cardiac manifestations. Investigators are exploring the therapeutic use of monoclonal antibodies and new somatostatin analogues. In this review, we cover current knowledge about the pathophysiology, diagnosis, and treatment of carcinoid heart disease.
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13
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Eriksson J, Garmo JEH, Ihre-Lundgren C, Hellman P. Prognostic factors for death after surgery for small intestinal neuroendocrine tumours. BJS Open 2018; 2:345-352. [PMID: 30263986 PMCID: PMC6156160 DOI: 10.1002/bjs5.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/23/2018] [Indexed: 01/01/2023] Open
Abstract
Background Neuroendocrine tumours of the small intestine (SI-NETs) are rare gastrointestinal neoplasms with an annual incidence of about one per 100 000. Patients with apparently similar tumours have variable outcomes. The aim of this study was to identify postoperative prognostic factors identifiable after initial surgery. Methods This was a nested case-control study of patients with SI-NETs who were treated between 1961 and 2001. Data were retrieved from the Swedish Cancer Registry. Patients who died from the SI-NET and corresponding controls (who outlived cases by at least 1 month), matched by age at diagnosis and calendar period, were included. Sex, postoperative symptoms, postoperative 5-hydroxyindoleacetic acid (5-HIAA) values, European Neuroendocrine Tumor Society (ENETS) stage, insufficiency of the tricuspid valve, radical secondary surgery and secondary malignancy were studied as potential prognostic factors. Results In total, 1122 patients were included (561 cases, 561 controls). Postoperative factors of prognostic importance included hormone-related symptoms, stage IV disease, raised levels of 5-HIAA, insufficiency of the tricuspid valve, secondary surgery not being macroscopically radical and a second malignancy. Conclusion Stage and symptomatic disease are important prognostic factors in SI-NET.
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Affiliation(s)
- J Eriksson
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - J E H Garmo
- Regional Oncological Centre Uppsala University Uppsala Sweden.,Cancer Epidemiology Unit, Division of Cancer Studies King's College London London UK
| | - C Ihre-Lundgren
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - P Hellman
- Department of Surgical Sciences Uppsala University Uppsala Sweden
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Abstract
PURPOSE OF REVIEW To review recent advances and controversies in all aspects of carcinoid-syndrome. RECENT FINDINGS Over the last few years there have been a number of advances in all aspects of carcinoid syndrome as well as new therapies. These include new studies on its epidemiology which demonstrate it is increasing in frequency; increasing insights into the pathogenesis of its various clinical manifestations and into its natural history: definition of prognostic factors; new methods to verify its presence; the development of new drugs to treat its various manifestations, both initially and in somatostatin-refractory cases; and an increased understanding of the pathogenesis, natural history and management of carcinoid heart disease. These advances have generated several controversies and these are also reviewed. SUMMARY There have been numerous advances in all aspects of the carcinoid-syndrome, which is the most common functional syndrome neuroendocrine tumors produce. These advances are leading to new approaches to the management of these patients and in some cases to new controversies.
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Affiliation(s)
- Tetsuhide Ito
- Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, International University of Health and Welfare
| | - Lingaku Lee
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, Maryland, USA
| | - Robert T Jensen
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, Maryland, USA
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Khay K, Arous S, Bentaoune T, Drighil A, Habbal R. Carcinoid heart disease revealed by cyanosis with both right and left valvular involvement: a case report. J Med Case Rep 2018; 12:23. [PMID: 29386066 PMCID: PMC5791312 DOI: 10.1186/s13256-018-1574-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/15/2018] [Indexed: 01/02/2023] Open
Abstract
Background Carcinoid heart disease is a frequent complication of carcinoid syndrome. It is related to the release by the carcinoid tumor and/or its metastases of bioactive substances such as serotonin. It is characterized by right-sided valvular involvement and can lead to right-sided heart failure. It is a prognostic factor of carcinoid syndrome. Case presentation We report the case of a 53-year-old African woman with an endocrine tumor of her small intestine complicated by carcinoid heart disease, revealed by right-sided heart failure. The diagnosis was confirmed by transthoracic echocardiography, which showed a severe tricuspid regurgitation with a patent foramen ovale, and by increased serum chromogranin A and urinary 5-hydroxyindoleacetic acid. Initially she was treated with medical therapy (furosemide and injection of somatostatin). Afterwards she was proposed for surgery. The evolution of her treatment was good. Conclusions Carcinoid syndrome is complicated in 60% of the cases of a heart disease, and is responsible for an important morbidity and mortality. The prognosis of patients with carcinoid heart disease has improved in recent years through somatostatin analogues and the cardiac surgery.
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Affiliation(s)
- Khadija Khay
- Department of Cardiology, Ibn Rushd University Hospital, Casablanca, Morocco
| | - Salim Arous
- Department of Cardiology, Ibn Rushd University Hospital, Casablanca, Morocco.
| | - Tarik Bentaoune
- Department of Cardiology, Ibn Rushd University Hospital, Casablanca, Morocco
| | - Abdenasser Drighil
- Department of Cardiology, Ibn Rushd University Hospital, Casablanca, Morocco
| | - Rachida Habbal
- Department of Cardiology, Ibn Rushd University Hospital, Casablanca, Morocco
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16
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Castillo J, Silvay G, Weiner M. Anesthetic Management of Patients With Carcinoid Syndrome and Carcinoid Heart Disease: The Mount Sinai Algorithm. J Cardiothorac Vasc Anesth 2017; 32:1023-1031. [PMID: 29273478 DOI: 10.1053/j.jvca.2017.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Javier Castillo
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY; Center for Carcinoid and Neuroendocrine Tumors, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY.
| | - George Silvay
- Department of Anesthesiology, Division of Cardiac Anesthesia, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - Menachem Weiner
- Department of Anesthesiology, Division of Cardiac Anesthesia, The Mount Sinai Hospital, Mount Sinai Health System, New York, NY
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17
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Surgical treatment of carcinoid syndrome metastatic disease: Partial hepatectomy with veno-venous bypass and subsequent tricuspid valve replacement. Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Giraldo M, Harle C, Lopera-Velásquez LM, Dobkowsky W. Tratamiento quirúrgico de la enfermedad metastásica del síndrome carcinoide: hepatectomía parcial usando un bypass veno-venoso y posterior cambio valvular tricúspide. Reporte de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Surgical treatment of carcinoid syndrome metastatic disease: Partial hepatectomy with veno-venous bypass and subsequent tricuspid valve replacement. Case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Diagnosing and Managing Carcinoid Heart Disease in Patients With Neuroendocrine Tumors: An Expert Statement. J Am Coll Cardiol 2017; 69:1288-1304. [PMID: 28279296 DOI: 10.1016/j.jacc.2016.12.030] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/08/2016] [Accepted: 12/10/2016] [Indexed: 12/17/2022]
Abstract
Carcinoid heart disease is a frequent occurrence in patients with carcinoid syndrome and is responsible for substantial morbidity and mortality. The pathophysiology of carcinoid heart disease is poorly understood; however, chronic exposure to excessive circulating serotonin is considered one of the most important contributing factors. Despite recognition, international consensus guidelines specifically addressing the diagnosis and management of carcinoid heart disease are lacking. Furthermore, there is considerable variation in multiple aspects of screening and management of the disease. The aim of these guidelines was to provide succinct, practical advice on the diagnosis and management of carcinoid heart disease as well as its surveillance. Recommendations and proposed algorithms for the investigation, screening, and management have been developed based on an evidence-based review of the published data and on the expert opinion of a multidisciplinary consensus panel consisting of neuroendocrine tumor experts, including oncologists, gastroenterologists, and endocrinologists, in conjunction with cardiologists and cardiothoracic surgeons.
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Bertin N, Favretto S, Pelizzo F, Mos L, Pertoldi F, Vriz O. Carcinoid Heart Disease: Starting From Heart Failure. J Investig Med High Impact Case Rep 2017. [PMID: 28634593 PMCID: PMC5468767 DOI: 10.1177/2324709617713511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Carcinoid syndrome is the constellation of symptoms mediated by humoral factors produced by some carcinoid tumors. It consists primarily of vasomotor symptoms, gastrointestinal hypermotility, hypotension, and bronchospasm, due to the production and release of vasoactive substances. Carcinoid heart disease occurs in more than 50% of patients with carcinoid syndrome; in some cases, it represents the initial manifestation of the disease. We report the case of a 75-year-old woman with a metastatic neuroendocrine tumor admitted to the emergency room for fatigue and heart failure. Transthoracic echocardiography showed severe tricuspid and pulmonic regurgitation suggesting carcinoid heart disease. A hypervascular retroperitoneal mass was found on abdominal computed tomography, which seemed to arise from the mesenteric artery, anteriorly to the abdominal aorta. Unfortunately, our patient was neither a candidate for mass resection nor for cardiac surgery due to advanced metastatic disease and poor clinical condition. Additionally, we performed a systematic literature review of carcinoid heart disease focusing on typical echocardiographic findings.
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Affiliation(s)
| | | | | | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | - Olga Vriz
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
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22
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Abstract
Tricuspid valve stenosis (TS) is rare, affecting less than 1% of patients in developed nations and approximately 3% of patients worldwide. Detection requires careful evaluation, as it is almost always associated with left-sided valve lesions that may obscure its significance. Primary TS is most frequently caused by rheumatic valvulitis. Other causes include carcinoid, radiation therapy, infective endocarditis, trauma from endomyocardial biopsy or pacemaker placement, or congenital abnormalities. Surgical management of TS is not commonly addressed in standard cardiac texts but is an important topic for the practicing surgeon. This paper will elucidate the anatomy, pathophysiology, and surgical management of TS.
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Affiliation(s)
- Marisa Cevasco
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Prem S Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Mulvey CK, Bergsland EK. Systemic Therapies for Advanced Gastrointestinal Carcinoid Tumors. Hematol Oncol Clin North Am 2016; 30:63-82. [PMID: 26614369 DOI: 10.1016/j.hoc.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Well-differentiated gastrointestinal neuroendocrine tumors (GINETs) tend to be slow growing, but treatment of advanced disease remains a challenge. Somatostatin analogues (SSAs) are considered standard therapy for carcinoid syndrome. SSAs delay tumor progression in advanced well-differentiated gastroenteropancreatic NETs. Cytotoxic chemotherapy and interferon play a limited role in the treatment of nonpancreatic GINETs. There is no standard approach to treatment of patients with disease progression. Identification of systemic agents with antitumor activity in advanced disease remains an unmet medical need. Enrollment to clinical trials is encouraged; potential therapeutic targets include the vascular endothelial growth factor and mammalian target of rapamycin signaling pathways.
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Affiliation(s)
- Claire K Mulvey
- Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, Box 0119, San Francisco, CA 94143, USA
| | - Emily K Bergsland
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, 1600 Divisadero Street, A727, San Francisco, CA 94115, USA.
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Laule M, Pschowski R, Pape UF, Pavel M, Stangl V, Baumann G, Wiedenmann B, Stangl K. Staged Catheter-Based Valve Treatment of Severe Carcinoid Heart Disease. Neuroendocrinology 2016; 103:259-62. [PMID: 26138598 DOI: 10.1159/000437167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Carcinoid heart disease (CHD) with severe valve destruction represents the major cause of high morbidity and mortality in patients with carcinoid syndrome. In this paper, we present a novel interventional treatment approach and report the first clinical result achieved in a patient with extensive CHD. METHODS AND RESULTS A woman with an ileal neuroendocrine tumour (G2, Ki67: 5%) presented with severe CHD (NYHA IV) affecting both the pulmonary and the tricuspid valve. First, a balloon-expandable 23-mm Edwards SAPIEN™ was successfully implanted percutaneously into the pulmonary valve. Since no catheter-based techniques were available for the replacement of the native tricuspid valve, we implanted an Edwards SAPIEN 26-mm valve into the vena cava inferior between the right atrium and the ostium of the hepatic veins to reduce abdominal congestion. The implantation was technically successful and completely prevented regurgitation into the vena cava inferior and abdominal veins. After this procedure, the patient's clinical condition improved significantly, and she achieved near-normal exercise tolerance (VO2 max: 24.4 ml O2/kg/min, NYHA II). CONCLUSION We demonstrated that percutaneous valve implantation may offer a novel, minimally invasive option in high-risk patients with severe CHD.
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Affiliation(s)
- Michael Laule
- Department of Cardiology and Angiology, Campus Mitte, Charitx00E9; - University Medicine Berlin, Berlin, Germany
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Dobson R, Valle J, Burgess M, Poston G, Cuthbertson D. Variation in Cardiac Screening and Management of Carcinoid Heart Disease in the UK and Republic of Ireland. Clin Oncol (R Coll Radiol) 2015; 27:741-6. [DOI: 10.1016/j.clon.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/22/2015] [Accepted: 06/16/2015] [Indexed: 12/18/2022]
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26
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Myocardial metastases on 6-[18F] fluoro-L-DOPA PET/CT: a retrospective analysis of 116 serotonin producing neuroendocrine tumour patients. PLoS One 2014; 9:e112278. [PMID: 25397775 PMCID: PMC4232397 DOI: 10.1371/journal.pone.0112278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/09/2014] [Indexed: 12/15/2022] Open
Abstract
Purpose This study evaluates the prevalence of cardiac metastases in patients with serotonin producing neuroendocrine tumours (NET), examined with 18F-FDOPA PET/CT, and the relationship of these metastases to the presence of carcinoid heart disease (CHD) based on echocardiography. Background CHD occurs in patients with serotonin producing NET. The diagnostic method of choice remains echocardiography. The precise prevalence of cardiac metastases is unknown given the limitations of standard technologies. Nuclear medicine modalities have the potential to visualize metastases of NET. Methods All patients who underwent 18F-FDOPA PET/CT because of serotonin producing NET between November 2009 and May 2012 were retrospectively analyzed. The presence of cardiac metastasis was defined as myocardial tracer accumulation higher than the surrounding physiological myocardial uptake. Laboratory tests and transthoracic echocardiography (TTE) results were digitally collected. Results 116 patients (62 male) underwent 18F-FDOPA PET/CT, mean age was 61±13 years. TTE was performed in 79 patients. Cardiac metastases were present in 15 patients, of which 10 patients also underwent TTE. One patient had both cardiac metastasis (only on 18F-FDOPA PET/CT) and echocardiographic signs of CHD. There were no differences in echocardiographic parameters for CHD between patients with and without cardiac metastases. TTE in none of the 79 patients showed cardiac metastases. Conclusion The prevalence of cardiac metastases detected with 18F-FDOPA PET/CT in this study is 13%. 18F-FDOPA PET/CT can visualize cardiac metastases in serotonin producing NET patients. There appears to be no relationship between the presence of cardiac metastases and TTE parameters of CHD.
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27
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Abstract
Carcinoid tumours pose a great challenge to anaesthesiologist, especially if carcinoid syndrome is present. We report peri-operative management of a patient with carcinoid syndrome who underwent upper lobectomy. Pre-operative optimisation for 10 days before surgery with injection octreotide and administration on the day of surgery as per guidelines was followed (North American Neuroendocrine Tumour Society guidelines). Our main goals were to prevent mediator release, avoidance of triggering factors and management of peri-operative carcinoid crisis. During tumour handling patient developed carcinoid crisis which was effectively treated with intravenous bolus octreotide and increasing rate of infusion.
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Affiliation(s)
- Prasoon Gupta
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
| | - Ranvinder Kaur
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
| | - Lalita Chaudhary
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
| | - Aruna Jain
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College, New Delhi, India
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28
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Dobson R, Burgess MI, Pritchard DM, Cuthbertson DJ. The clinical presentation and management of carcinoid heart disease. Int J Cardiol 2014; 173:29-32. [PMID: 24636550 DOI: 10.1016/j.ijcard.2014.02.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/14/2014] [Accepted: 02/22/2014] [Indexed: 12/31/2022]
Abstract
Carcinoid heart disease is a major cause of morbidity and mortality in patients with metastatic neuroendocrine tumours (NETs). Although cases of carcinoid syndrome and severe carcinoid heart disease requiring urgent intervention are well described, many patients with significant carcinoid heart disease may have insidious symptoms or even be asymptomatic. As haemodynamically significant carcinoid heart disease may be clinically silent, specific and individualised considerations must be made as to the most appropriate clinical criteria and time point at which surgical valve replacement should be undertaken in patients with carcinoid heart disease.
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Affiliation(s)
- R Dobson
- Neuroendocrine Tumour Group, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK; Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, L69 3GA, UK.
| | - M I Burgess
- Neuroendocrine Tumour Group, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK; Department of Cardiology, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - D M Pritchard
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, L69 3GE, UK; Neuroendocrine Tumour Group, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - D J Cuthbertson
- Neuroendocrine Tumour Group, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK; Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, L69 3GA, UK
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29
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Melo P, Cahill TJ, Kardos A. A hot flush signals the way to a woman's heart. Int J Cardiol 2014; 171:e131-2. [PMID: 24438931 DOI: 10.1016/j.ijcard.2013.12.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Pedro Melo
- Department of Cardiology, Milton Keynes NHS Hospital Foundation Trust Standing Way Milton Keynes, United Kingdom
| | - Thomas J Cahill
- Department of Cardiology, Milton Keynes NHS Hospital Foundation Trust Standing Way Milton Keynes, United Kingdom
| | - Attila Kardos
- Department of Cardiology, Milton Keynes NHS Hospital Foundation Trust Standing Way Milton Keynes, United Kingdom.
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Abstract
OPINION STATEMENT Carcinoid is a rare neuroendocrine tumor that typically originates in the gastrointestinal tract and can result in a constellation of symptoms, mediated by vasoactive substances, referred to as carcinoid syndrome. Carcinoid valve and heart disease is characterized by the plaque-like, endocardial fibrous tissue deposits, primarily affecting the right heart endocardium and valves, which result as a consequence of the disease process. Potential mechanisms for the carcinoid valve disease include the complex role of excess serotonin and its interaction with serotonin receptors and transporters. Carcinoid valve and heart disease is a frequent occurrence in patients with carcinoid syndrome and is accountable for substantial morbidity and mortality. Cardiac surgery remains the most effective treatment option for carcinoid valve disease and a multidisciplinary approach at an experienced center is recommended for patients with metastatic carcinoid and carcinoid heart disease.
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Affiliation(s)
- J Wells Askew
- Cardiovascular Diseases, Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA,
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Dobson R, Cuthbertson DJ, Burgess MI. The optimal use of cardiac imaging in the quantification of carcinoid heart disease. Endocr Relat Cancer 2013; 20:R247-55. [PMID: 23883478 DOI: 10.1530/erc-13-0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Carcinoid heart disease is a rare cause of right-sided valvular dysfunction, primarily mediated by serotonin. It is an important complication in patients with carcinoid syndrome and occurs in 20-50% of such patients. Echocardiography is the main technique used for the assessment of carcinoid heart disease, but other imaging modalities are also important, particularly in the quantification of the severity of the disease. We sought to review the role of cardiac imaging in the assessment of carcinoid heart disease.
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Affiliation(s)
- Rebecca Dobson
- Department of Cardiology, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
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Reversible right-sided heart failure secondary to carcinoid crisis. Case Rep Crit Care 2013; 2013:487801. [PMID: 24804121 PMCID: PMC4010008 DOI: 10.1155/2013/487801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/12/2013] [Indexed: 11/17/2022] Open
Abstract
Carcinoid crisis is an infrequent and little-described complication of neuroendocrine tumors that can be life threatening. It may develop during induction of anesthesia, intraoperatively, during tumor manipulation and arterial embolization, or even spontaneously. The massive release of neuroendocrine substances can lead to potentially fatal complications. Somatostatin analogs inhibit the release of these substances and are the mainstay of treatment. The following case report describes a patient with reversible acute right-sided heart failure posterior to hepatic artery embolization.
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Amano Y, Mandai M, Baba T, Hamanishi J, Yoshioka Y, Matsumura N, Konishi I. Recurrence of a carcinoid tumor of the ovary 13 years after the primary surgery: A case report. Oncol Lett 2013; 6:1241-1244. [PMID: 24179502 PMCID: PMC3813716 DOI: 10.3892/ol.2013.1530] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/14/2013] [Indexed: 11/06/2022] Open
Abstract
The current study presents the case of a patient with a recurrent carcinoid tumor of the ovary, 13-years after the primary surgery. The primary surgery consisted of a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a left ovarian tumor at 54 years old. Pathologically, the tumor was diagnosed as a carcinoid tumor of the ovary. Following the primary treatment, the patient was admitted to a cardiologist due to carcinoid-induced heart failure. At 67 years old, the patient was referred to Kyoto University Hospital with a solitary mass 8 cm in diameter and located in the paraaortic area, which was detected by routine ultrasonography and subsequent computed tomography (CT) scans. Urinary 5-hydroxyindole acetate (5-HIAA), a serotonin degradation metabolite, was present at elevated levels. With a diagnosis of a recurrent carcinoid tumor, the patient underwent a tumor resection. The pathological diagnosis was that of lymph node metastasis of the trabecular carcinoid. Post-operatively, the 5-HIAA levels returned to normal. Carcinoid tumors occasionally recur following surgery due to borderline malignant potential. Due to the slow growing nature of these tumors, in specific cases, recurrence occurs following a long interval. Therefore, a relatively long follow-up period is required.
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Affiliation(s)
- Yasuaki Amano
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Bryson GL. Rarity and review: evidence-based practice for uncommon diseases. Can J Anaesth 2013; 60:419-22. [DOI: 10.1007/s12630-013-9908-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 02/11/2013] [Indexed: 11/30/2022] Open
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Bencze A, Szücs N, Igaz P, Leiszter K, Nagy Z, Patócs A, Rácz K. [Carcinoid heart disease]. Orv Hetil 2013; 154:546-50. [PMID: 23545233 DOI: 10.1556/oh.2013.29583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Carcinoids are rare tumors originating from neuroendocrine cells. A large proportion of these tumors produce serotonin and other biologically active hormones which may produce carcinoid syndrome characterized by flushing, diarrhoea and bronchospasm. Carcinoid heart disease, a rare complication of carcinoid syndrome, may itself have a great impact on life expectancy of patients with carcinoid syndrome. The authors present a case history of a patients with carcinoid heart disease and they review the symptoms, diagnosis and therapeutic options of this rare complication of carcinoid syndrome.
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Affiliation(s)
- Agnes Bencze
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest.
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Geller SA, Campos FPF. Carcinoid heart disease. AUTOPSY AND CASE REPORTS 2013; 3:67-68. [PMID: 31528600 PMCID: PMC6671877 DOI: 10.4322/acr.2013.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Stephen A Geller
- Department of Pathology and Laboratory Medicine - David Geffen School of Medicine, UCLA, Los Angeles/CA - USA
| | - Fernando P F Campos
- Department of Internal Medicine - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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Castillo JG, Milla F, Adams DH. Surgical Management of Carcinoid Heart Valve Disease. Semin Thorac Cardiovasc Surg 2012; 24:254-60. [DOI: 10.1053/j.semtcvs.2012.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 12/15/2022]
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Castillo JG, Silvay G, Solís J. Current concepts in diagnosis and perioperative management of carcinoid heart disease. Semin Cardiothorac Vasc Anesth 2012; 17:212-23. [PMID: 23171718 DOI: 10.1177/1089253212465475] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Carcinoid tumors are neuroendocrine tumors with a very unpredictable clinical behavior. In the setting of hepatic metastases, the tumor's release of bioactive substances into the systemic circulation results in carcinoid syndrome: a constellation of symptoms among which cutaneous flushing, gastrointestinal hypermotility, and cardiac involvement are the most prominent. Cardiac manifestations, also known as carcinoid heart disease, are secondary to a severe fibrotic reaction which frequently involves the right-sided valves and may extend towards the subvalvular apparatus leading to valve thickening and retraction. Left-sided involvement is rare and mostly observed in the presence of an interatrial shunt, endobronchial tumor localization, and high tumor activity. Echocardiographic techniques often reveal noncoaptation of the valves, which are fixed in a semiopen position. In patients with advanced lesions and severe valvular dysfunction, surgery is currently the only definitive treatment to potentially improve quality of life and provide survival benefit. Although cardiac surgery has been traditionally reserved for those patients with symptomatic right ventricular failure, a significant trend towards improved surgical outcomes has triggered a more liberal referral for valve replacement. Carcinoid heart disease poses two distinct challenges for the anesthesiologist: carcinoid crisis and low cardiac output syndrome secondary to right ventricular failure. Carcinoid crisis, characterized by flushing, hypotension, and bronchospasm, may be precipitated by catecholamines and histamine releasing drugs used routinely in patients undergoing valve surgery. Although a broader utilization of octreotide have significantly simplified the anesthetic and perioperative management of these patients, a very balanced anesthetic technique is required to identify and manage low cardiac output syndrome.
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Engelsman AF, van Duijvendijk P, Groenemeijer BE, van der Zaag E, Spronk PE, Katinakis A. Tricuspid valve regurgitation as a presenting symptom of metastasized carcinoid tumor. Case Rep Gastroenterol 2012; 6:643-9. [PMID: 23139656 PMCID: PMC3492999 DOI: 10.1159/000343594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A 66-year-old woman was diagnosed with hepatic metastasized carcinoid tumor of the ileocecal junction resulting in elevated plasma chromogranin A levels and urinary 5-hydroxyindoleacetic acid (5-HIAA) levels. Further examination showed right-sided heart failure with severe tricuspid valve regurgitation. Carcinoid tumors produce serotonin which leads to flushing, secretory diarrhea, bronchospasm and hypotension, known as carcinoid syndrome. Serotonin is metabolized to 5-HIAA, which is inactive, in the liver and the lungs. However, hepatic metastases may result in direct exposure of the heart to serotonin, which induces plaque-like deformities on the tricuspid valve, and in turn induces valve regurgitation. This condition is known as carcinoid heart disease. Tricuspid valve regurgitation may induce risk of massive blood loss in case of liver surgery through high-volume backflow in the hepatic veins. This report shows the clinical relevance of carcinoid heart disease in the perioperative setting.
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Affiliation(s)
- Anton F Engelsman
- Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
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Ramirez GA, Franchini S, Rovere-Querini P, Sabbadini MG, Manfredi AA, Maugeri N. The role of platelets in the pathogenesis of systemic sclerosis. Front Immunol 2012; 3:160. [PMID: 22719739 PMCID: PMC3376452 DOI: 10.3389/fimmu.2012.00160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/29/2012] [Indexed: 12/15/2022] Open
Abstract
Systemic sclerosis (SSc) is an inflammatory disease of unknown etiology characterized by widespread organ dysfunction due to fibrosis and ischemia. Its nebulous pathogenic background and the consequent absence of an etiological therapy prevent the adoption of satisfying treatment strategies, able to improve patients’ quality of life and survival and stimulate researchers to identify a unifying pathogenic target. Platelets show a unique biological behavior, lying at the crossroads between vascular function, innate and adaptive immunity, and regulation of cell proliferation. Consequently they are also emerging players in the pathogenesis of many inflammatory diseases, including SSc. In the setting of SSc platelets are detectable in a persistent activated state, which is intimately linked to the concomitant presence of an injured endothelium and to the widespread activation of the innate and adaptive immune system. As a consistent circulating source of bioactive compounds platelets contribute to the development of many characteristic phenomena of SSc, such as fibrosis and impaired vascular tone.
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Affiliation(s)
- Giuseppe A Ramirez
- Department of Immunology, San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
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