1
|
Mouser B, Howe JR, Atari O, Dillon JS, Chandrasekharan C, Parekh KR, Bashir MA. Screening for carcinoid heart disease: Trends and future Perspectives. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 22:200293. [PMID: 38911359 PMCID: PMC11190706 DOI: 10.1016/j.ijcrp.2024.200293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024]
Abstract
Background Screening for carcinoid heart disease (CHD), has historically lacked consensus expert guidelines. In 2017, the North American Neuroendocrine Tumor Society (NANETS) released expert recommendations for CHD screening among NET patients to improve CHD detection. The objective of this study is to evaluate CHD screening trends and utility of screening guidelines over more than two decades at a single tertiary care center. Materials and methods Patients with NETs referred for abdominal surgical evaluation at a single tertiary care center were included, 300 patients from 1999 to 2018 and 34 patients from 2021 to 2022. Lab values for the following NANETS-proposed criteria at any point during their treatments were recorded: NETs with liver metastasis, blood serotonin >5 times upper limit of normal (>1000 ng/mL), NT-ProBNP >260 pg/mL and clinical features suggestive of CHD. Results 85 % (285/334) of patients included in this study met one or more expert-recommended CHD screening criteria. However, 40 % (132/285) of patients meeting one or more criteria received CHD screening via echocardiogram at some point following NET diagnosis. While rates of screening for patients increased from the first decade to the second decade (32 % vs 40.6 %), the rates were much higher after guideline publication (70 %, 24/34). Furthermore, patients meeting multiple screening criteria were more likely to have evidence of structural valve disease. Conclusions Results of this study suggest that utilization of these four expert-recommended screening criteria have greatly increased rates of CHD screening via echocardiogram and could assist in improving early CHD detection, especially for patients meeting multiple criteria.
Collapse
Affiliation(s)
- Bryan Mouser
- University of Iowa Hospitals and Clinics Department of Cardiothoracic Surgery, Iowa City, IA, USA
| | - James R. Howe
- University of Iowa Hospitals and Clinics Department of Surgical Oncology, Iowa City, IA, USA
| | - Olivia Atari
- University of Iowa Hospitals and Clinics Department of Cardiothoracic Surgery, Iowa City, IA, USA
| | - Joseph S. Dillon
- University of Iowa Hospitals and Clinics Department of Endocrinology, Iowa City, IA, USA
| | | | - Kalpaj R. Parekh
- University of Iowa Hospitals and Clinics Department of Cardiothoracic Surgery, Iowa City, IA, USA
| | - Mohammad A. Bashir
- University of Iowa Hospitals and Clinics Department of Cardiothoracic Surgery, Iowa City, IA, USA
| |
Collapse
|
2
|
Broncano J, Hanneman K, Ghoshhajra B, Rajiah PS. Cardiac Computed Tomography of Native Cardiac Valves. Radiol Clin North Am 2024; 62:399-417. [PMID: 38553177 DOI: 10.1016/j.rcl.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Valvular heart disease (VHD) is a significant clinical problem associated with high morbidity and mortality. Although not being the primary imaging modality in VHD, cardiac computed tomography (CCT) provides relevant information about its morphology, function, severity grading, and adverse cardiac remodeling assessment. Aortic valve calcification quantification is necessary for grading severity in cases of low-flow/low-gradient aortic stenosis. Moreover, CCT details significant information necessary for adequate percutaneous treatment planning. CCT may help to detail the etiology of VHD as well as to depict other less frequent causes of valvular disease, such as infective endocarditis, valvular neoplasms, or other cardiac pseudomasses.
Collapse
Affiliation(s)
- Jordi Broncano
- Cardiothoracic Imaging Unit, Radiology Department, Hospital San Juan de Dios, HT Medica, Avenida El Brillante Nº 36, Córdoba 14012, Spain.
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G2N2, Canada
| | - Brian Ghoshhajra
- Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charles River Plaza East, 165 Cambridge Street, Boston, MA 02114, USA
| | | |
Collapse
|
3
|
Herrera-Martínez AD, Fuentes-Fayos AC, Sanchez-Sanchez R, Montero AJ, Sarmento-Cabral A, Gálvez-Moreno MA, Gahete MD, Luque RM. Does Telotristat Have a Role in Preventing Carcinoid Heart Disease? Int J Mol Sci 2024; 25:2036. [PMID: 38396713 PMCID: PMC10888480 DOI: 10.3390/ijms25042036] [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: 11/29/2023] [Revised: 01/18/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Carcinoid heart disease (CHD) is a frequent and life-threatening complication in patients with carcinoid tumors. Its clinical management is challenging is some cases since serotonin-induced valve fibrosis leads to heart failure. Telotristat is an inhibitor of tryptophan-hydroxylase (TPH), a key enzyme in serotonin production. Telotristat use in patients with carcinoid syndrome and uncontrollable diarrhea under somatostatin analogs is approved, but its specific role in patients with CHD is still not clear. IN this context, we aimed to explore the effect of telotristat in heart fibrosis using a mouse model of serotonin-secreting metastasized neuroendocrine neoplasm (NEN). To this aim, four treatment groups (n = 10/group) were evaluated: control, monthly octreotide, telotristat alone, and telotristat combined with octreotide. Plasma serotonin and NT-proBNP levels were determined. Heart fibrosis was histologically evaluated after 6 weeks of treatment or when an individual mouse's condition was close to being terminal. Heart fibrosis was observed in all groups. Non-significant reductions in primary tumor growth were observed in all of the treated groups. Feces volume was increased in all groups. A non-significant decrease in feces volume was observed in the octreotide or telotristat-treated groups, while it was significantly reduced with the combined treatment at the end of the study compared with octreotide (52 g reduction; p < 0.01) and the control (44.5 g reduction; p = 0.05). Additionally, plasma NT-proBNP decreased in a non-significant, but clinically relevant, manner in the octreotide (28.2% reduction), telotristat (45.9% reduction), and the octreotide + telotristat (54.1% reduction) treatment groups. No significant changes were observed in plasma serotonin levels. A similar non-significant decrease in heart valve fibrosis was observed in the three treated groups. In conclusion, Telotristat alone and especially in combination with octreotide decreases NT-proBNP levels in a mouse model of serotonin-secreting metastasized NEN, when compared with the control and octreotide, but its effect on heart valve fibrosis (alone and in combination) was not superior to octreotide in monotherapy.
Collapse
Affiliation(s)
- Aura D. Herrera-Martínez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - Antonio C. Fuentes-Fayos
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, 14004 Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), 14004 Córdoba, Spain
- Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Rafael Sanchez-Sanchez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Pathology Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - Antonio J. Montero
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, 14004 Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), 14004 Córdoba, Spain
- Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - André Sarmento-Cabral
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, 14004 Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), 14004 Córdoba, Spain
- Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - María A. Gálvez-Moreno
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - Manuel D. Gahete
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, 14004 Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), 14004 Córdoba, Spain
- Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Raúl M. Luque
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (A.C.F.-F.); (R.S.-S.); (A.J.M.); (A.S.-C.); (M.A.G.-M.); (M.D.G.)
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, 14004 Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), 14004 Córdoba, Spain
- Reina Sofia University Hospital, 14004 Cordoba, Spain
| |
Collapse
|
4
|
Laschinsky C, Welsner M, Mahabadi AA, Lahner H, Hautzel H. NET-Induced Carcinoid Heart Disease Affecting Both Tricuspid and Aortic Valves Due to Patent Foramen Ovale and Right/Left Shunt: A Multi-imaging Challenge to Nuclear Medicine. Clin Nucl Med 2024; 49:157-159. [PMID: 38178372 DOI: 10.1097/rlu.0000000000005004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
ABSTRACT Carcinoid heart disease (Hedinger syndrome) is a long-term consequence in hormone-active neuroendocrine tumors with hepatic metastases and carcinoid syndrome. Because of serotonin, excess multiple cardiac and pulmonary symptoms evolve, which are further complicated by a patent foramen ovale due to right-left shunting. We present a 53-year-old man with an ileum-neuroendocrine tumor including gross liver metastases and long-term stable disease who subsequently developed Hedinger syndrome. Initially experiencing progressive dyspnea, he eventually experienced severe hypoxemia due to patent foramen ovale. 99mTc-MAA lung perfusion scintigraphy quantitatively identified the right-left shunting, whereas 68Ga-FAPI-46 PET/CT characterized the typical fibrous heart valve thickening due to serotonin-induced fibroblast proliferative properties.
Collapse
Affiliation(s)
| | - Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen
| | | | | |
Collapse
|
5
|
Mohd Nasri FA, Osman N, O'Sullivan S. Carcinoid Heart Disease and a Complicated Course of Progressive Gastroenteropancreatic Neuroendocrine Neoplasia: A Case Report. Case Rep Oncol 2024; 17:658-665. [PMID: 39015641 PMCID: PMC11250385 DOI: 10.1159/000539257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/06/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are a relatively rare, heterogenous group of malignancies originating from secretory cells of the neuroendocrine system. Carcinoid syndrome is a complication of neuroendocrine tumours, characterized by a triad of flushing, bronchospasm, and diarrhoea. This is due to the release of serotonin and other vasoactive substances by the tumour. Elevated levels of serotonin can also cause fibrotic changes in the structures of the heart, which can lead to cardiac complications termed carcinoid heart disease. We report the case of a 64-year-old man diagnosed with carcinoid heart disease 19 years after his initial diagnosis of grade 2 GEP-NET with liver metastases. Case Presentation The patient presented with symptoms of shortness of breath, lower limb swelling, abdominal swelling, and chest pain. He was on treatment with subcutaneous lanreotide 120 mg twice weekly prior to admission. An echocardiogram showed moderate tricuspid regurgitation and mitral regurgitation but preserved left ventricular systolic function, consistent with right heart failure. A CT pulmonary angiogram showed a small volume left lingula pulmonary embolism with bilateral pleural effusions and stable pericardial effusion with evidence of right ventricular strain. The patient was started on IV furosemide 40 mg twice daily, SC octreotide 100 μg three times daily, and therapeutic tinzaparin. The patient was discharged following successful diuresis. Conclusion This case report highlights the importance of regular echocardiogram and cardiovascular checkups in patients with carcinoid tumours and liver metastases. A multidisciplinary approach involving medical oncologists, cardiothoracic surgeons, and cardiologists is vital in ensuring early treatment and preventing late-stage complications of carcinoid heart disease.
Collapse
Affiliation(s)
| | - Nemer Osman
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Shane O'Sullivan
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
6
|
Khan SA, Devkota D, Chaudhary RK, Luitel A, Parajuli SB, Bista M, Rayamajhi A. Molecular biology of carcinoid heart disease: Seeking therapeutic targets in the era of targeted therapy. Medicine (Baltimore) 2023; 102:e36043. [PMID: 38013349 PMCID: PMC10681439 DOI: 10.1097/md.0000000000036043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023] Open
Abstract
Carcinoid tumors (CT) are among the least studied tumors. It is a relatively rare and slow-growing tumor with good survival in its primary form. However, metastatic carcinoid tumor comes up with many different complications contributing to increased morbidity and mortality. Metastatic form of the disease has a wide spectrum of clinical manifestations and multisystem involvement including cardiovascular manifestations, neurological manifestations, and psychiatric manifestations and so on. In this review, we are centered towards the cardiovascular manifestations of the disease, which, by far, is one of the commonest causes of death in these patients. Being a neuroendocrine tumor, cardiovascular manifestations are mainly because of biologically active substances, produced by the tumor cells, remodeling the heart. Development of targeted therapies against carcinoid heart diseases is currently limited by lack of understanding of pathophysiology of the disease processes. In this review, we aim to figure out the spectrum of carcinoid heart diseases, along with the molecular biology of the changes going on, which, in turn, will not only pave a way to the development of targeted therapies but will also extend opportunities for molecular screening of the tumor and diagnosis at an early stage, thereby, reducing the morbidity and mortality.
Collapse
Affiliation(s)
| | | | - Rahul Kumar Chaudhary
- Department of Anesthesiology and Critical Care, Birat Medical College Teaching Hospital, Morang, Nepal
| | - Anish Luitel
- Birat Medical College Teaching Hospital, Morang, Nepal
| | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang, Nepal
| | - Madhab Bista
- Department of Cardiovascular Medicine, Birat Medical College Teaching Hospital, Morang, Nepal
| | - Asmita Rayamajhi
- Department Radiation Oncology, Birat Medical College Teaching Hospital, Morang, Nepal
| |
Collapse
|
7
|
Cope J, Maclean R, Hota S, Ramage JK, Mullholland N, Clement D, Brown S, Piper S, MaCarthy P, Wendler O, Srirajaskanthan R. Improving outcomes in carcinoid heart disease - learning from a single centre. Nucl Med Commun 2023; 44:968-976. [PMID: 37661777 DOI: 10.1097/mnm.0000000000001749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
INTRODUCTION A significant proportion of patients with carcinoid syndrome develop carcinoid heart disease (CHD). Valve degeneration can lead to right heart failure, and worsening prognosis. Replacement of affected valves is an effective therapy. We reviewed patients treated with valve replacement to assess prognostic factors. METHODS CHD patients records who underwent valve replacement from 2003-2019 were reviewed. RESULTS Twenty-six patients underwent valve replacement. Mean (SD) age was 61 (11) years, 54% female. Eleven tumours were grade G1, with the remaining G2. NYHA pre-surgery mean (SD) 2.0 (0.7); post-surgery mean 1.2; follow-up mean (SD) 1.6 (0.8). Mean NYHA score difference from pre- to post-surgery -0.71 ( P = 0.002). 88.5% two (PR & TR), 3.9% one, 3.9% three and 3.9% four valves replaced. 13 patients received Lu177 oxodotreotide; 27% completed four cycles. Mortality at 1 and 5 years follow up was 42% and 50% respectively. Cox proportional hazards model of survival from surgery, adjusting for age [hazard ratio (HR) 0.96 (0.89-1.03) ( P = 0.25)], four cycles of Lu177 oxodotreotide demonstrated HR 0.087 (0.0079-0.95) ( P = 0.045) indicating improved survival. DISCUSSION Surgical patients were often NYHA grade II, and symptoms improved post-surgery. Four cycles of Lu177 oxodotreotide improved survival, although the confidence interval was wide. Further studies should be performed to assess Lu177 oxodotreotide in CHD.
Collapse
Affiliation(s)
- Jack Cope
- Department of Gastroenterology, King's College Hospital
| | - Rory Maclean
- Department of Gastroenterology, King's College Hospital
| | - Shweta Hota
- Department of Gastroenterology, King's College Hospital
| | - John K Ramage
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
- Department of Gastroenterology, Hampshire Hospitals, Basingstoke
| | | | - Dominique Clement
- Department of Gastroenterology, King's College Hospital
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
| | - Sarah Brown
- Department of Gastroenterology, King's College Hospital
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
| | - Sue Piper
- Department of Cardiology, King's College Hospital
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Raj Srirajaskanthan
- Department of Gastroenterology, King's College Hospital
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
| |
Collapse
|
8
|
El Gabry M, Arends S, Shehada SE, Lahner H, Kamler M, Wendt D, Spetsotaki K. Hedinger Syndrome-Lessons Learnt: A Single-Center Experience. J Cardiovasc Dev Dis 2023; 10:413. [PMID: 37887860 PMCID: PMC10607344 DOI: 10.3390/jcdd10100413] [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: 08/29/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Hedinger syndrome (HS) or carcinoid heart disease (CD) is a rare and challenging manifestation of malignant neuroendocrine tumours (NETs) involving the heart. We aimed to report our experience with surgical strategies and midterm results in HS patients. METHODS Eleven patients (58 ± 11 (range 41 to 79 years); 5 females) with HS who underwent cardiac surgery in our department between 07/2005 and 05/2023 were analysed. RESULTS All patients showed a New York Heart Association (NYHA) class III-IV and in all the tricuspid valve (TV) was involved. Four patients received a TV replacement, and three TV reconstruction. Recently, to preserve the geometry and function of the compromised right ventricle (RV), we have applied the TV "bio-prosthesis in native-valve" implantation technique with the preservation of the valve apparatus (tricuspid valve implantation: TVI) in four cases. Concomitant procedures included pulmonary valve replacement in four, pulmonary implantation in one, and aortic valve replacement in three cases. To treat RV failure, we adapted a combined TandemHeart®-CytoSorb® haemoperfusion strategy in Patient #10 and venoarterial extracorporeal membrane oxygenation (V-A ECMO) support avoidance, after experiencing an ECMO-induced carcinoid-storm-related death in Patient #8. Mortality at 30 days was 18% (2/11). The median follow up was 2 ± 2.1 years (range 1 month to 6 years) with an overall mortality during the follow-up period of 72.7% (8/11). CONCLUSIONS HS surgery, despite being a high-risk procedure, can efficiently prolong survival, and represents a safe and feasible procedure. However, patient selection seems to be crucial. Further follow up and larger cohorts are needed.
Collapse
Affiliation(s)
- Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
| | - Sven Arends
- Department for Anesthesiology and Intensive Care Medicine, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
| | - Harald Lahner
- Department of Endocrinology and Metabolism, University Hospitals Duisburg-Essen, 45147 Essen, Germany;
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
- CytoSorbents Europe GmbH, 12587 Berlin, Germany
| | - Konstantina Spetsotaki
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, 45147 Essen, Germany; (M.E.G.); (M.K.); (D.W.)
| |
Collapse
|
9
|
Beyer M, Kasarla R, Shoap S, Beyer E. Quadruple Valve Replacement in Carcinoid Heart Disease: A Case Report. Cureus 2023; 15:e45547. [PMID: 37868527 PMCID: PMC10588539 DOI: 10.7759/cureus.45547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
This report details a rare case of left-sided carcinoid heart disease (CHD). In CHD, vasoactive substances released from carcinoid tumors cause fibrous tissue formation on the right side of the heart. These substances are usually inactivated by monoamine oxidase A in the lungs, safeguarding the left side of the heart. Exceptions include the presence of a patent foramen ovale (PFO), pulmonary metastasis, or elevated serotonin levels. Intriguingly, our patient exhibited significant left-sided involvement without these factors, ultimately requiring a quadruple valve replacement surgery. After eight months post-operation, the patient is stable with no cardiovascular complications. This rare case of CHD, along with its outcome, hints at potential unidentified etiologies for left-sided CHD and underscores valve replacement as a viable treatment.
Collapse
Affiliation(s)
- Maria Beyer
- Department of Cardiothoracic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Rishabh Kasarla
- Department of Cardiothoracic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Seth Shoap
- Department of Cardiothoracic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Erik Beyer
- Department of Cardiothoracic Surgery, Palmetto General Hospital, Hialeah, USA
| |
Collapse
|
10
|
Kudelka MR, Abou-Alfa GK, O’Reilly EM, Foote MB, Sirohi B, Elias R, Shamseddine A, Paroder V, Moussa AM, Cohen P, Ganesh K. Metastatic well differentiated serotonin-producing pancreatic neuroendocrine tumor with carcinoid heart disease: a case report. J Gastrointest Oncol 2023; 14:1878-1886. [PMID: 37720425 PMCID: PMC10502540 DOI: 10.21037/jgo-22-909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/08/2023] [Indexed: 09/19/2023] Open
Abstract
Background Less than two percent of pancreatic neuroendocrine tumors (NETs) produce serotonin. Serotonin can cause carcinoid syndrome and less commonly carcinoid heart disease (CHD). CHD is associated with increased mortality and requires a more aggressive approach. Here we present a rare case of a serotonin-producing pancreatic NET complicated by CHD at presentation and discuss timing of systemic therapy, liver-directed therapy, and heart failure management. Case Description A 36-year-old white man presented with diarrhea, lower extremity edema, and exertional dyspnea. He was found to have a well-differentiated serotonin-producing pancreatic NETs grade three with bilobar liver metastasis complicated by carcinoid syndrome and CHD. His symptoms and disease burden improved with somatostatin analog and liver-directed therapy with bland embolization to control carcinoid symptoms and obtain rapid hormonal control to prevent progression of CHD. He concurrently received diuretics to manage his heart failure and was considered for valvular replacement surgery, which was deferred for optimal hormonal control. Conclusions Our case highlights the importance of multidisciplinary care for patients with pancreatic NETs and early identification and management of CHD. Although uncommon, serotonin-producing pancreatic NETs can present with CHD and require combination of somatostatin analogs, liver-directed therapy, and heart failure management.
Collapse
Affiliation(s)
- Matthew R. Kudelka
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Eileen M. O’Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Michael B. Foote
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | | | - Rawad Elias
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | - Ali Shamseddine
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Viktoriya Paroder
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Amgad M. Moussa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Paul Cohen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - Karuna Ganesh
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| |
Collapse
|
11
|
Meir J, Michaud L, Frishman WH, Aronow WS. The Past, Present, and The Future of Carcinoid Heart Disease. Cardiol Rev 2023; 31:193-198. [PMID: 36515580 DOI: 10.1097/crd.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Carcinoid heart disease is a frequent manifestation of carcinoid syndrome. It results from the release of a large amount of serotonin and subsequently fibrosis of right sided heart valves, that is, tricuspid and pulmonic valve. This article reviews the pathogenesis, clinical symptoms, diagnosis, treatment and prognosis of carcinoid heart disease. Recent developments in treating carcinoid heart disease have improved the poor prognosis associated with the disease.
Collapse
Affiliation(s)
- Juliet Meir
- From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Vaslhalla, NY
| | | | | | | |
Collapse
|
12
|
Sharma A, Fierro ME, Pak S, Thallapureddy K, Awobajo M, Hui D, Otchere P. Late-stage diagnosis of carcinoid heart disease due to lack of access to health care. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:28. [PMID: 37277819 DOI: 10.1186/s40959-023-00176-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
Carcinoid syndrome (CS) is a unique constellation of symptoms caused by release of vasoactive substances from neuroendocrine tumors (Pandit et al., StatPearls, 2022). Neuroendocrine tumors are rare with an annual incidence of 2 in 100,000 people (Ram et al., 46:21-27, 2019). Up to 50% of patients with these tumors will develop carcinoid syndrome, which is characterized by symptoms caused by elevated levels of serotonin and most commonly include fatigue, flushing, wheezing, and non-specific gastrointestinal symptoms such as diarrhea and malabsorption (Pandit et al., StatPearls, 2022) (Fox et.al., 90:1224-1228, 2004). Over time, patients with carcinoid syndrome can develop carcinoid heart disease (CHD). CHD refers to the cardiac complications that occur when the vasoactive substances, such as serotonin, tachykinins, and prostaglandins, secreted from the carcinoid tumors. These complications most commonly include valvular abnormalities, but can also present as coronary artery damage, arrhythmias or direct myocardial injury (Ram et al., 46:21-27, 2019). While CHD is not typically an initial feature of carcinoid syndrome, it does eventually occur in up to 70% of patients with carcinoid tumors (Ram et al., 46:21-27, 2019) (Jin et.al., 146:65-73, 2021) (Macfie et.al., 224:665-669, 2022). CHD is associated with significant morbidity and mortality due to the risk of progressive heart failure (Bober et.al., 14:1179546820968101, 2020). In this case, we describe a 35-year-old Hispanic woman in South Texas with undiagnosed carcinoid syndrome for over 10 years that eventually progressed to severe CHD. In this patient's case, we emphasize how lack of access to healthcare resulted in delay of diagnosis, appropriate treatment, and worsened prognosis in this young patient.
Collapse
Affiliation(s)
- Aditi Sharma
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Maria E Fierro
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Stella Pak
- Department of Neurology, Albany Medical College, 43 New Scotland Ave, Albany, NY, 12208, 518-262-5521, USA.
| | - Keerthi Thallapureddy
- Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Moyosore Awobajo
- Department of Pathology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Dawn Hui
- Department of Cardio-Thoraic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| | - Prince Otchere
- Department of Cardio-Oncology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas, 78229, 210-567-7000, USA
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
The Surgical Management of Lung Neuroendocrine Neoplasms. Cancers (Basel) 2023; 15:cancers15061695. [PMID: 36980581 PMCID: PMC10046489 DOI: 10.3390/cancers15061695] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
This review summarizes key recent developments relevant to the surgical management of lung neuroendocrine neoplasms (L-NENs), including typical and atypical carcinoids, large cell neuroendocrine carcinoma, and small cell lung carcinoma. This review includes recent insights into the classification, clinical presentation, diagnostic workup, treatment options, and follow-up. Highlighted topics include general principles of surgery in localized or locally advanced or metastatic L-NENs, lung-sparing surgery for small, peripheral typical carcinoids, adjuvant and systemic therapies for typical and atypical carcinoids, and surgery and adjuvant therapies for large cell neuroendocrine carcinoma and small cell lung carcinoma.
Collapse
|
15
|
Marketou ME, Kapsoritakis N, Bourogianni O, Patrianakos A, Kochiadakis G, Plevritaki A, Papadaki S, Zervakis S, Parthenakis F, Koukouraki S. Hybrid imaging of neuroendocrine tumors in the heart: Union is strength. J Nucl Cardiol 2023; 30:298-312. [PMID: 34622428 DOI: 10.1007/s12350-021-02804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
Cardiac neuroendocrine tumors (NETs) are particularly rare tumors that can lead to a very poor clinical outcome, partly because of metastases but mainly because of manifestations of the hormonal activity they exhibit. Prompt diagnosis is important in order to start the most effective treatment for their removal or management, with the fewest complications. They are often difficult to diagnose, especially in their early stages. One of the reasons for this is that the heart is an organ with a high rate of metabolism and is located in close proximity to other high-metabolism organs. In addition, the anatomic location and their small size render their diagnosis extremely challenging. In recent years, hybrid imaging methods have revolutionized the diagnostic approach to oncology patients and have established a place in the diagnosis of cardiac NETs, because they provide both anatomical and functional information at the same time. Positron emission tomography/computed tomography (PET/CT), PET/magnetic resonance imaging (PET/MRI) and single-photon emission computed tomography/CT (SPECT/CT) are widely used in clinical practice because of the very important metabolic information, the high sensitivity and specificity. However, prospective studies are needed to confirm the true clinical and prognostic value of various hybrid imaging diagnostic techniques in cardiac NETs.
Collapse
Affiliation(s)
- Maria E Marketou
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece.
| | - Nikolaos Kapsoritakis
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Olga Bourogianni
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandros Patrianakos
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - George Kochiadakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Anthoula Plevritaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Papadaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Stelios Zervakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Fragiskos Parthenakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Koukouraki
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| |
Collapse
|
16
|
Konsek-Komorowska SJ, Pęczkowska M, Kolasińska-Ćwikła AD, Cichocki A, Konka M, Roszkowska-Purska K, Ćwikła JB. Analysis of Patients with NET G1/G2 Neuroendocrine Tumors of the Small Intestine in the Course of Carcinoid Heart Disease-A Retrospective Study. J Clin Med 2023; 12:jcm12030790. [PMID: 36769439 PMCID: PMC9918269 DOI: 10.3390/jcm12030790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Neuroendocrine neoplasms of the small intestine (SI-NENs) are one of the most commonly recognized gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). Carcinoid heart disease (CHD) is the primary cause of death in patients with the carcinoid syndrome (CS). The aim of this retrospective study was to evaluate possible factors impacting upon overall survival (OS) in subjects with both neuroendocrine tumors (NETs) G1/G2 of the small intestine (SI-NET) and CHD. Enrolled in our study of 275 patients with confirmed G1/G2 SI-NET, were 28 (10%) individuals with CHD. Overall survival was assessed using the Kaplan-Meier method. The Cox-Mantel test was used to determine how OS varied between groups. A Cox proportional hazards model was used to conduct univariate analyses of predictive factors for OS and estimate hazard ratios (HRs). Of the 28 individuals with confirmed carcinoid heart disease, 12 (43%) were found to have NET G1 and 16 (57%) were found to have NET G2. Univariate analysis revealed that subjects with CHD and without resection of the primary tumor had a lower OS. Our retrospective study observed that patients who presented with CHD and without resection of primary tumor had worse prognosis of survival. These results suggest that primary tumors may need to be removed when feasible, but further research is needed. However, no solid recommendations can be issued on the basis of our single retrospective study.
Collapse
Affiliation(s)
- Sonia J. Konsek-Komorowska
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
- Correspondence:
| | - Mariola Pęczkowska
- The Cardinal Stefan Wyszyński National Institute of Cardiology, 04-628 Warsaw, Poland
| | | | - Andrzej Cichocki
- The Maria Sklodowska-Curie National Research Institute of Oncology, 02-034 Warsaw, Poland
| | - Marek Konka
- The Cardinal Stefan Wyszyński National Institute of Cardiology, 04-628 Warsaw, Poland
| | | | - Jarosław B. Ćwikła
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
- Diagnostic and Therapeutic Center–Gammed, 02-351 Warsaw, Poland
| |
Collapse
|
17
|
Honan KA, Hassan S, Deswal A, Herrmann J, Song J, Monlezun D, Halperin D, Mahvash A, Dasari A, Koutroumpakis E, Akay M, Balanescu DV, de Armas IS, Patel M, Nathan S, Kar B, Marmagkiolis K, Lopez-Mattei J, Patel J, Gregoric I, Yao J, Iliescu CA. Bioprosthetic valve monitoring in patients with carcinoid heart disease. Front Cardiovasc Med 2023; 9:1072890. [PMID: 36712267 PMCID: PMC9878394 DOI: 10.3389/fcvm.2022.1072890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
Background Carcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with neuroendocrine tumors and carcinoid syndrome. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the outcomes of patients after valve replacement. Methods We conducted a multi-institution retrospective registry of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. Patients were followed post-operatively with echocardiographic studies every 3 months. Carcinoid valvular heart disease scores were used to monitor valve degeneration. Neuroendocrine tumor treatment, their administration times, and associations with echocardiographic findings were recorded. Results Of 87 patients with CnHD, 22 patients underwent simultaneous surgical TV and PV replacement. In 6 patients (27.3%), increased PV Vmax was the first echocardiographic manifestation of valve degeneration in the setting of occult neurohormonal release. Post-operative telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize PV Vmax. The PV Vmax showed consistent elevation in the entire patient population when compared to baseline, while bioprosthetic TV echocardiographic parameters were relatively unchanged throughout. Post-operative warfarin therapy did not affect the rate of PV degeneration, and no major bleeding was recorded during or after post-operative anticoagulation therapy. Conclusion Bioprosthetic valve degeneration is common in CnHD. Monitoring with echocardiographic studies every 3 months, focusing on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies may have a beneficial impact on valve degeneration.
Collapse
Affiliation(s)
- Kevin A. Honan
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Juhee Song
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dominique Monlezun
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Daniel Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Armeen Mahvash
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Akay
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dinu-Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ismael Salas de Armas
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Manish Patel
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sriram Nathan
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Heart and Vascular Institute, Texas Medical Center, Houston, TX, United States
| | - Biswajit Kar
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Heart and Vascular Institute, Texas Medical Center, Houston, TX, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jay Patel
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Igor Gregoric
- Department of Cardiothoracic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - James Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar A. Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Cezar A. Iliescu,
| |
Collapse
|
18
|
Balancing carcinoid crisis and right ventricular dysfunction during tricuspid and pulmonic valve replacement for carcinoid heart disease: A case report. Int J Surg Case Rep 2023; 102:107855. [PMID: 36610355 PMCID: PMC9829749 DOI: 10.1016/j.ijscr.2022.107855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Carcinoid tumors are rare malignancies of neuroendocrine origin that can manifest with a constellation of systemic symptoms including right-sided cardiac involvement. Many patients with carcinoid heart disease require valve replacement, but intraoperative management of carcinoid syndrome varies within the literature. CASE PRESENTATION A 72-year-old man with carcinoid syndrome underwent tricuspid and pulmonic valve replacement with multiple episodes of carcinoid crisis intraoperatively as well as right ventricular dysfunction after cardiopulmonary bypass. CLINICAL DISCUSSION Octreotide is the mainstay in prevention and treatment of intraoperative carcinoid crisis, but reported dosages and timing varies significantly. The use of exogenous catecholamines is also controversial as they are thought to paradoxically worsen carcinoid symptoms. Our patient was managed successfully with both an octreotide infusion and intermittent boluses, as well as exogenous catecholamines for right ventricular support during and after cardiopulmonary bypass. CONCLUSION The management of carcinoid syndrome in patients undergoing valve surgery for carcinoid heart disease is dependent on timely prevention and treatment of carcinoid crisis and effective mitigation of right ventricular dysfunction.
Collapse
|
19
|
Li J, Li A, Zhai Y, Li L, Zhang Y, Chen A, Tao X, Gao Q, Xie W, Zhai Z. Prevalence and risk prediction value of tricuspid regurgitation by echocardiography in precapillary pulmonary hypertension. BMC Pulm Med 2022; 22:409. [PMID: 36352385 PMCID: PMC9644528 DOI: 10.1186/s12890-022-02207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background In precapillary pulmonary hypertension (PH), the incidence of different tricuspid regurgitation (TR) degree is poorly defined. The impact of TR severity on pulmonary artery pressure (PAP) assessment and clinical risk stratification in precapillary PH remains unclear. Methods A total of 207 patients diagnosed precapillary PH who underwent right heart catheterization (RHC) and echocardiography within 3 days were included. The severity of TR was graded as trace, mild, moderate and severe. Pearson correlation analysis was performed to evaluate the correlation between systolic PAP by echocardiography (sPAPECHO) and mean PAP by RHC (mPAPRHC) in different TR degree groups. The impact factors on risk stratification of precapillary PH were analyzed by logistic regression analysis. Results The proportion of None, Trace, Mild, Moderate and Severe TR group was 2.4%, 23.7%, 39.1%, 28.5% and 6.3% respectively. Right atrium (RA) area increased gradually with TR aggravation (p < 0.001). Moderate and Severe TR group had higher N-terminal pro-B-type natriuretic peptide (p < 0.001), right atrial pressure (RAP) (p = 0.018), right ventricular basal diameter (RVD)/left ventricular basal diameter (LVD) ratio (p < 0.001), larger right ventricle (RV) (p < 0.001) and lower tricuspid annular plane systolic excursion (p = 0.006) compared with Trace and Mild group. TR-sPAPECHO in Moderate TR group had the greatest correlation coefficient with mPAPRHC (0.742, p < 0.001) followed by Mild (0.635, p < 0.001) and severe group (0.592, p = 0.033), while there was no correlation in Trace TR group (0.308, p = 0.076). Multivariate logistic regression showed three significant independent echocardiography predictors of high-risk precapillary PH: RVD/LVD ratio (OR = 5.734; 95%CI1.502–21.889, p = 0.011), RA area (OR 1.054; 95% CI 1.004–1.107, p = 0.035) and systolic annular tissue velocity of the lateral tricuspid annulus (S’) (OR 0.735, 95% CI 0.569–0.949, p = 0.018). Conclusions Precapillary PH was not necessarily accompanied by significant TR. None or Trace TRaccounted for 26% in our population and TR-sPAPECHO was not applicable to estimate PAP in these patients. RVD/LVD ratio, RA area and S’ can independently predict the high-risk patients with precapillary PH. TR may play an indirect role in risk stratification by affecting these indicators.
Collapse
|
20
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 797] [Impact Index Per Article: 398.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
21
|
Li S, Wang X, Sui X, Zhang X, Yin M, Yang J. Clinical characteristics and survival outcomes in patients with ovarian strumal carcinoid. BMC Cancer 2022; 22:1090. [PMID: 36280824 PMCID: PMC9594919 DOI: 10.1186/s12885-022-10167-5] [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: 05/27/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian strumal carcinoid is an extremely rare ovarian malignant tumor with limited data on clinical characteristics and survival outcomes. METHODS A retrospective study of 119 patients was conducted, including 98 cases identified from literature review, and their clinical characteristics were investigated. The overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and potential prognostic factors of these patients were also evaluated. RESULTS Lesions of 115 cases were confined to the ovarian while four patients presented with extra-ovarian disease upon initial diagnosis. Surgical treatment options performed in this cohort varied, 5.0% received ovarian cystectomy, 36.1% received unilateral salpingo-oophorectomy (USO), 7.6% received bilateral salpingo-oophorectomy (BSO), 42.0% received hysterectomy with BSO, and 8.4% underwent debulking surgery. Moreover, one patient did not undergo any surgery. No postoperative adjuvant therapy was administered in 89.9% patients, while 7.6% and 2.5% received adjuvant radiotherapy and chemotherapy, of which two patients received combined radiation and chemotherapy. At the final follow-up, 89.1% patients showed no evidence of the disease, and 5.0% were alive with the disease. Only seven deaths occurred, with two attributed to the tumor. The 5-year, 10-year, and 20-year OS rates were 96.0%, 85.0%, and 85.0%, respectively, with a 15-year recurrence rate of 4.4%. The 5-year and 20-year DSS rate were 98.5% and 95.9%. Multivariate Cox regression showed age ≥ 55 years was the only risk factor associated with the OS (P = 0.014, OR 7.988; 95% CI 1.519 - 42.004). However, the univariate and multivariate Cox regression showed no potential risk factor for RFS and DSS. CONCLUSION Patients with ovarian strumal carcinoid have an excellent prognosis irrespective of the surgical option. Conservative surgery especially USO with individualized adjuvant therapy is recommended.
Collapse
Affiliation(s)
- Sijian Li
- grid.413106.10000 0000 9889 6335National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaoxue Wang
- grid.413106.10000 0000 9889 6335National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaolong Sui
- grid.440323.20000 0004 1757 3171Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Xinyue Zhang
- grid.413106.10000 0000 9889 6335National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Min Yin
- grid.413106.10000 0000 9889 6335National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiaxin Yang
- grid.413106.10000 0000 9889 6335National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| |
Collapse
|
22
|
Levy S, Korse CE, de Groot ACA, Meijer RCA, Tesselaar MET, Valk GD. Four decades of experience with carcinoid heart disease: An analysis of 84 patients. J Neuroendocrinol 2022; 34:e13199. [PMID: 36256859 DOI: 10.1111/jne.13199] [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: 02/22/2022] [Revised: 07/15/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
Abstract
Carcinoid heart disease (CHD) is a serious cardiac condition which is caused by elevated serotonin in the systemic circulation, secreted by neuroendocrine tumours (NET). It mostly affects the right-sided heart valves, where it causes fibrotic disturbances and is associated with worse survival. In this study, we describe a large cohort of patients with CHD and provide an insight into their survival over the past decades. All consecutive patients with a serotonin producing NET and CHD referred to the Netherlands Cancer Institute that presented with CHD or developed CHD during their follow up time were included from 1984 until 2021. Patients were divided into three time periods: 1984-2000, 2000-2010 and 2010-2018. Median N-terminal pro B-type natriuretic protein (NT-proBNP) and serum serotonin levels were stratified according to tricuspid regurgitation severity. Kaplan-Meier curves and log rank test were used for visualisation of survival. Cox regression was used for identification of the characteristics associated with disease specific mortality (DSM). A total of 84 patients with CHD were included of whom 49 (58.3%) were male. Median age at NET diagnosis was 62.3 (range 23.9-81.7) years, and median time to development of CHD was 1.1 (range 0-24.2) years. NT-proBNP was significantly higher when more severe tricuspid regurgitation (TR) was present (p = .027). Median survival from CHD diagnosis for 1984-2000, 2000-2010 and 2010-2018 were 1.3 (confidence interval [CI]: 0.9-1.6), 1.9 (CI: 1.2-2.6) and 3.9 (CI: 1.7-6.2) years (p = .025). Valve replacement surgery (VSR) occurred more frequent in later time periods. VSR (hazard ratio [HR] 0.33, p = .005) and NT-proBNP (HR 1.003, 1.00-1.005, p = .036) were significantly associated with DSM. The prognosis of patients with CHD has improved over the past decades, possibly caused by more VSR. NT-proBNP is a valuable biomarker in patients with CHD. Clinical practice should be aimed at timely diagnosis and intervention of CHD.
Collapse
Affiliation(s)
- Sonja Levy
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Catherina E Korse
- Department of Clinical Chemistry, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Andre C A de Groot
- Department of Cardiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ronald C A Meijer
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Margot E T Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| |
Collapse
|
23
|
Zahr F, Chadderdon S, Song H, Sako E, Fuss C, Bailey SR, Cigarroa J. Contemporary diagnosis and management of severe tricuspid regurgitation. Catheter Cardiovasc Interv 2022; 100:646-661. [DOI: 10.1002/ccd.30364] [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: 06/10/2021] [Revised: 04/23/2022] [Accepted: 07/09/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Firas Zahr
- Division of Cardiology, Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
| | - Scott Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
| | - Howard Song
- Division of Cardiac Surgery, Knight Cardiovascular Institute Oregon Health & Science University Portland Orego USA
| | - Edward Sako
- Department of Cardiothoracic Surgery UT Health San Antonio San Antonio Texas USA
| | - Cristina Fuss
- Department of Radiology Oregon Health & Science University Portland Oregon USA
| | - Steven R. Bailey
- Department of Internal Medicine LSU Health Shreveport School of Medicine Shreveport Louisiana USA
| | - Joaquin Cigarroa
- Division of Cardiology, Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
| |
Collapse
|
24
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
25
|
Cali N, Falat C, Bontempo L, Gatz D. 60-year-old Female with Edema. Clin Pract Cases Emerg Med 2022; 6:198-203. [PMID: 36049202 PMCID: PMC9436491 DOI: 10.5811/cpcem.2022.4.57085] [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: 04/11/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Many patients present to the emergency department (ED) with nonspecific, acute-on-chronic complaints. It requires a thorough diagnostic approach and broad differential diagnosis to determine whether there is serious, undiagnosed pathology. Case Presentation: A 60-year-old female presented to the ED for gradually worsening bilateral lower extremity swelling with associated abdominal distension, ascites, diarrhea, vomiting, and weight loss. Discussion: This case takes the reader through the evaluation of a patient with acute-on-chronic complaints who presented in a decompensated state.
Collapse
Affiliation(s)
- Nikki Cali
- University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Cheyenne Falat
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Laura Bontempo
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - David Gatz
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| |
Collapse
|
26
|
Wang X, Kuban-Johnston D, Lapuerta P, Lacerda CMR. Telotristat ethyl reverses myxomatous changes in mice mitral valves. Front Cardiovasc Med 2022; 9:945672. [PMID: 35990981 PMCID: PMC9386075 DOI: 10.3389/fcvm.2022.945672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Rationale Myxomatous mitral valve degeneration is a common pathological manifestation of mitral valve regurgitation, with or without valvular prolapse. In addition to similarities between naturally occurring and serotonergic valve degeneration, an increasing body of evidence has recently suggested that serotonin signaling is a regulator of degenerative valvulopathies. Studies have found that serotonin can be synthesized locally by valvular cells and serotonin receptors in turn may be activated to promote signaling. Recently, telotristat ethyl (TE) has been introduced as a treatment for carcinoid disease, by selectively inhibiting tryptophan hydroxylase 1, the rate-limiting enzyme in peripheral serotonin synthesis. TE provides a unique tool to test inhibition of serotonin synthesis in vivo, without impacting brain serotonin, to further confirm the role of local serotonin synthesis on heart valves. Objective To confirm the link between serotonin and myxomatous valvular disease in vivo. Methods and results A hypertension-induced myxomatous mitral valve disease mouse model was employed to test the effect of TE on valvular degeneration. Circulating serotonin and local serotonin in valve tissues were tested by enzyme immunoassay and immunohistochemistry, respectively. TE was administrated in two modes: (1) parallel with angiotensin II (A2); (2) post A2 treatment. Myxomatous changes were successfully recapitulated in hypertensive mice, as determined by ECM remodeling, myofibroblast transformation, and serotonin signaling activation. These changes were at least partially reversed upon TE administration. Conclusion This study provides the first evidence of TE as a potential therapeutic for myxomatous mitral disease, either used to prevent or reverse myxomatous degeneration.
Collapse
Affiliation(s)
- Xinmei Wang
- Department of Bioengineering, Shenyang University, Shenyang, China
| | | | - Pablo Lapuerta
- Lexicon Pharmaceuticals, Basking Ridge, NJ, United States
| | - Carla M. R. Lacerda
- Department of Chemical Engineering, The University of Texas at Tyler, Tyler, TX, United States
| |
Collapse
|
27
|
Ghukasyan H. Hedinger Syndrome: A Rare Cardiac Manifestation of Carcinoid Syndrome. Cureus 2022; 14:e26528. [PMID: 35795576 PMCID: PMC9250807 DOI: 10.7759/cureus.26528] [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] [Accepted: 07/03/2022] [Indexed: 11/16/2022] Open
Abstract
Carcinoid syndrome can cause desmoplastic reactions to nearby tissues. When it involves the heart, it causes carcinoid heart disease (CHD) or Hedinger syndrome and usually involves the right-sided heart valves, causing tricuspid insufficiency and pulmonary stenosis (TIPS) and eventually leading to right-sided heart failure. The management of patients with CHD is complex, as both the systemic malignant disease and the heart involvement have to be addressed. Its prompt diagnosis and early treatment is paramount as CHD is associated with increased morbidity and mortality. A 61-year-old Caucasian male with a recently diagnosed metastatic neuroendocrine tumor presented to the heart failure clinic with decompensated heart failure, anasarca, flushing and diarrhea. This case highlights the common clinical features of carcinoid syndrome, its cardiac manifestations and the pathophysiology underlying the manifestations and treatment decisions that involve addressing both systemic and cardiac manifestations.
Collapse
|
28
|
Valvular Heart Disease Epidemiology. Med Sci (Basel) 2022; 10:medsci10020032. [PMID: 35736352 PMCID: PMC9228968 DOI: 10.3390/medsci10020032] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.
Collapse
|
29
|
A CASE OF SCLERODERMA-LIKE LESIONS AS A CUTANEOUS MANIFESTATION OF CARCINOID SYNDROME. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100146] [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
|
30
|
Abstract
Carcinoid syndrome, a paraneoplastic condition linked with the release of multiple humoral factors, affects around 30-40% of patients with well-differentiated neuroendocrine tumours. Carcinoid syndrome has a major and unfavourable impact on patients' quality of life; it raises costs when compared to non-functioning neuroendocrine tumours; and it causes patients' lifestyles to alter, such as food, job, physical activity, and social life. Somatostatin analogues have been the first-line therapy for individuals with neuroendocrine tumours and carcinoid disease for decades. While these drugs give considerable relief from carcinoid syndrome symptoms, clinical progression is unavoidable, necessitating further research into newer treatment measures. Carcinoid tumours are sometimes difficult to diagnose because of their vague or nonspecific symptoms. There have been several advancements in all aspects of carcinoid syndrome, as well as novel therapeutics, in the previous few years. New epidemiological studies show that it is becoming more common; increasing insights into the pathogenesis of its various clinical manifestations and 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 the disease. An all language literature search was conducted on MEDLINE, COCHRANE, EMBASE, and Google Scholar till November 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: "Recent advances", "Carcinoid syndrome", "Neuroendocrine Neoplasms" and "Carcinoid heart disease". We comprehensively reviewed the literature on the pathogenesis, clinical features, and newer treatment modalities for Carcinoid Syndrome. Recent advancements in research and management have resulted from advances in our understanding of the aetiology of carcinoid syndrome. The development of molecular indicators of aggressiveness improved serum tumour markers, and the molecular aetiology of carcinoid heart disease are all possible because of advances in molecular biology. We conducted a comprehensive review to update knowledge regarding the pathophysiology, diagnostic protocols, and current and newer treatments for carcinoid syndrome, which presently requires a multidisciplinary approach, due to the complexity of the illness's aetiology, diagnosis, and therapy.
Collapse
|
31
|
Alghamdi A, Malibari AA, Al-Husayni F, Jabri A, Albugami S. Relentless Hypoxia in a Patient With Carcinoid Syndrome. Cureus 2021; 13:e20497. [PMID: 35047309 PMCID: PMC8760016 DOI: 10.7759/cureus.20497] [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] [Accepted: 12/18/2021] [Indexed: 11/05/2022] Open
Abstract
Patent foramen ovale (PFO) in patients with carcinoid heart disease (CHD) may result in hypoxia due to the presence of large right (R) to left (L) intracardiac shunts leading to hypoxia and worsening clinical condition. Percutaneous closure of the PFO can normalize oxygen saturation, relieve symptoms, and lessens left-sided heart valves involvement. We describe a case of a 70-year-old female patient with a history of small bowel neuroendocrine tumor on monthly octreotide infusion presented with worsening exertional dyspnea and hypoxia secondary to R to L intracardiac shunt through the PFO. The decision was made to close the PFO percutaneously with Amplatzer (Plymouth, MN: Abbott) PFO occluder device which resulted in immediate normalization of oxygen saturation and relief of her dyspnea.
Collapse
|
32
|
(Carcinoid heart disease in a patient with primary ovarian carcinoid). COR ET VASA 2021. [DOI: 10.33678/cor.2021.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
33
|
HAMEED T, KUMAR A, SINGH CB. Carcinoid Tumors: from the Past into the Future. MAEDICA 2021; 16:695-699. [PMID: 35261673 PMCID: PMC8897795 DOI: 10.26574/maedica.2020.16.4.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Carcinoids are a rare and slow growing tumor, having a propensity to affect all organs but most commonly involve the gastrointestinal tract, followed by lungs. Carcinoid tumors secrete a variety of peptides and neuroamines. Though clinical presentation is varied and depends on the involved organ along with produced neuroactive amines, common symptoms include flushing, explosive watery diarrhoea and bronchospasm. Estimation of 5-HIAA in 24-hour urine is highly specific. Serum chromogranin is highly sensitive even in non-secretory carcinoids. Octreoscan along with MIBG is a better diagnostic modality as compared to computed tomography or magnetic resonance imaging alone. Treatment involves a multidisciplinary approach, including resection of primary tumor and debulking, embolisation of liver carcinoids, somatostatin analogues and chemotherapy. Molecular target therapy with Sunitinib and Bevacizumab have been shown to have a promising role in treatment, with higher response rate and slower progression.
Collapse
Affiliation(s)
- Tariq HAMEED
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Awadh KUMAR
- Department of Surgery, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Chandra Bhushan SINGH
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| |
Collapse
|
34
|
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
| |
Collapse
|
35
|
Interventional Strategies in Cancer-induced Cardiovascular Disease. Curr Oncol Rep 2021; 23:133. [PMID: 34570291 DOI: 10.1007/s11912-021-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW To highlight the range of illnesses and procedures that the interventional onco-cardiologists face in their daily practice, along with the recent additions to anti-cancer therapies and their related cardiotoxicity. RECENT FINDINGS Immune checkpoint inhibitors (ICI) are not devoid of cardiotoxicity as thought earlier and lead to an increased incidence of myocarditis. Transcatheter valve replacement has been shown to be a safer alternative to surgical replacement in cancer patients. Interventional onco-cardiology is a novel field that addresses cardiovascular diseases in the setting of cancer. Traditionally excluding cancer patients from clinical trials has led to a dearth of information needed to tackle cardiac conditions like Takotsubo cardiomyopathy, malignant pericardial effusions, and radiation-induced vascular diseases encountered either exclusively or predominantly in this high-risk population. This review discusses the various treatment options available in the interventional armamentarium with a particular focus on ICI-myocarditis and transcatheter aortic valve replacement in cancer patients.
Collapse
|
36
|
O'Driscoll R, Prashar A, Youssef G, Sader M. Carcinoid heart disease of gonadal primary presenting with hypoxia: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa536. [PMID: 34124556 PMCID: PMC8189296 DOI: 10.1093/ehjcr/ytaa536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 11/12/2022]
Abstract
Background Carcinoid heart disease is a potential sequela of metastatic neuroendocrine tumour that has characteristic valve appearances. Patients can present with symptoms of carcinoid syndrome or be relatively asymptomatic until symptoms of progressive heart failure manifest. Case summary We present a case of a 54-year-old male who was admitted to the hospital for investigation of hypoxia. Transthoracic echocardiogram was suggestive of carcinoid heart disease which subsequently led to a diagnosis of metastatic neuroendocrine (carcinoid) tumour of the testicular primary. Work-up revealed a patent foramen ovale with evidence of the right to left interatrial shunt from severe tricuspid regurgitation as the cause of his hypoxia. Prior to surgical excision of the primary tumour, percutaneous patent foramen ovale closure was performed resulting in improved arterial oxygen saturation and symptomatic improvement. Discussion Carcinoid heart disease typically affects the right-sided cardiac valves and the tricuspid valve appearances were critical in leading to a diagnosis of a metastatic neuroendocrine tumour in our patient. This case demonstrates that percutaneous patent foramen ovale closure can be an effective intervention for hypoxia in those not managed surgically. A high index of suspicion should be maintained for gonadal primary carcinoid tumour when there is carcinoid heart disease in the absence of liver metastases.
Collapse
Affiliation(s)
- Ronan O'Driscoll
- Department of Cardiology, St George Hospital, Gray Street, Kogarah 2217, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Abhisheik Prashar
- Department of Cardiology, St George Hospital, Gray Street, Kogarah 2217, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - George Youssef
- Department of Cardiology, St George Hospital, Gray Street, Kogarah 2217, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mark Sader
- Department of Cardiology, St George Hospital, Gray Street, Kogarah 2217, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
37
|
Pulcini S, Berghian A, Edet-Sanson A, Carré F, Fontanilles M. Severe carcinoid syndrome revealing a primary ovarian carcinoid tumor. Bull Cancer 2021; 108:779-782. [PMID: 33867122 DOI: 10.1016/j.bulcan.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Serena Pulcini
- Cancer Centre Henri Becquerel, department of medical oncology, rue d'Amiens, 76000 Rouen, France
| | - Anca Berghian
- Cancer Centre Henri Becquerel, department of pathology, rue d'Amiens, 76000 Rouen, France
| | - Agathe Edet-Sanson
- Henri Becquerel Cancer Center and Rouen University Hospital, nuclear medicine department, Rouen, France; University of Rouen, faculty of medicine, QuantIF-LITIS (Équipe d'Accueil 4108), Rouen, France
| | - Fabienne Carré
- Jacques Monod Hospital, department of gynecology, Montivilliers, France
| | - Maxime Fontanilles
- Cancer Centre Henri Becquerel, department of medical oncology, rue d'Amiens, 76000 Rouen, France; Normandie université, Rouen University Hospital, UNIROUEN, IRON group, Normandy Centre for Genomic and Personalized Medicine, Inserm U1245, 76031 Rouen, France.
| |
Collapse
|
38
|
Chan DL, Pavlakis N, Crumbaker M, Lawrence B, Barber C, Price TJ, Michael M, Oberg K. Vigilance for carcinoid heart disease is still required in the era of somatostatin analogues: Lessons from a case series. Asia Pac J Clin Oncol 2021; 18:209-216. [PMID: 33852771 DOI: 10.1111/ajco.13577] [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: 12/08/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
AIM Carcinoid heart disease (CHD) is a well-documented complication of neuroendocrine tumors (NETs) due to secreted hormones causing fibrosis. Somatostatin analogues (SSAs) can decrease hormonal secretion and inhibit tumor growth. The reported incidence of CHD has decreased as SSA use has increased. We describe a series of patients who have developed CHD even though they were treated with SSA therapy. METHODS Nine patients were seen in four centers in Australia and New Zealand. The average duration of follow-up from diagnosis was 39 months. RESULTS Three patients had Grade 1 and six Grade 2 disease by World Health Organization 2010 criteria. All patients had no CHD symptoms at baseline and started SSA therapy soon after diagnosis, yet developed significant, symptomatic cardiac dysfunction in their disease course. The median time from NET diagnosis to SSA initiation was 1 month, and median time from NET diagnosis to CHD diagnosis was 23 months (range 4-52). All patients who were tested had persistently increased hormonal levels (chromogranin A, urinary 5-hydroxyindolacetic acid). CONCLUSIONS The good symptomatic control afforded by SSAs should not lead to reduced vigilance in screening for CHD, especially in patients with persistently elevated hormonal assays. Clinicians should consider regular echocardiographic screening in patients with a secretory syndrome.
Collapse
Affiliation(s)
- David L Chan
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Megan Crumbaker
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ben Lawrence
- Discipline of Oncology, University of Auckland, Auckland, New Zealand
| | - Camilla Barber
- The School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | - Michael Michael
- Division of Cancer Medicine & Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Kjell Oberg
- Department of Endocrine Oncology, University Hospital, Uppsala, Sweden
| |
Collapse
|
39
|
Fernandez CJ, Agarwal M, Pottakkat B, Haroon NN, George AS, Pappachan JM. Gastroenteropancreatic neuroendocrine neoplasms: A clinical snapshot. World J Gastrointest Surg 2021; 13. [PMID: 33796213 PMCID: PMC7993001 DOI: 10.4240/wjgs.v13.i3.231&set/a 886074439+803088391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Our understanding about the epidemiological aspects, pathogenesis, molecular diagnosis, and targeted therapies of neuroendocrine neoplasms (NENs) have drastically advanced in the past decade. Gastroenteropancreatic (GEP) NENs originate from the enteroendocrine cells of the embryonic gut which share common endocrine and neural differentiation factors. Most NENs are well-differentiated, and slow growing. Specific neuroendocrine biomarkers that are used in the diagnosis of functional NENs include insulin, glucagon, vasoactive intestinal polypeptide, gastrin, somatostatin, adrenocorticotropin, growth hormone releasing hormone, parathyroid hormone-related peptide, serotonin, histamine, and 5-hydroxy indole acetic acid (5-HIAA). Biomarkers such as pancreatic polypeptide, human chorionic gonadotrophin subunits, neurotensin, ghrelin, and calcitonin are used in the diagnosis of non-functional NENs. 5-HIAA levels correlate with tumour burden, prognosis and development of carcinoid heart disease and mesenteric fibrosis, however several diseases, medications and edible products can falsely elevate the 5-HIAA levels. Organ-specific transcription factors are useful in the differential diagnosis of metastasis from an unknown primary of well-differentiated NENs. Emerging novel biomarkers include circulating tumour cells, circulating tumour DNA, circulating micro-RNAs, and neuroendocrine neoplasms test (NETest) (simultaneous measurement of 51 neuroendocrine-specific marker genes in the peripheral blood). NETest has high sensitivity (85%-98%) and specificity (93%-97%) for the detection of gastrointestinal NENs, and is useful for monitoring treatment response, recurrence, and prognosis. In terms of management, surgery, radiofrequency ablation, symptom control with medications, chemotherapy and molecular targeted therapies are all considered as options. Surgery is the mainstay of treatment, but depends on factors including age of the individual, location, stage, grade, functional status, and the heredity of the tumour (sporadic vs inherited). Medical management is helpful to alleviate the symptoms, manage inoperable lesions, suppress postoperative tumour growth, and manage recurrences. Several molecular-targeted therapies are considered second line to somatostatin analogues. This review is a clinical update on the pathophysiological aspects, diagnostic algorithm, and management of GEP NENs.
Collapse
Affiliation(s)
- Cornelius J Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Mayuri Agarwal
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Nisha Nigil Haroon
- Department of Endocrinology and Internal Medicine, Northern Ontario School of Medicine, Sudbury P3E 2C6, Ontario, Canada
| | - Annu Susan George
- Department of Medical Oncology, VPS Lakeshore Hospital, Cochin 682040, Kerala, India
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, PR2 9HT, Preston, The University of Manchester, Oxford Road M13 9PL, Manchester Metropolitan University, All Saints Building M15 6BH, Manchester, United Kingdom.
| |
Collapse
|
40
|
Fernandez CJ, Agarwal M, Pottakkat B, Haroon NN, George AS, Pappachan JM. Gastroenteropancreatic neuroendocrine neoplasms: A clinical snapshot. World J Gastrointest Surg 2021; 13:231-255. [PMID: 33796213 PMCID: PMC7993001 DOI: 10.4240/wjgs.v13.i3.231] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/17/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
Our understanding about the epidemiological aspects, pathogenesis, molecular diagnosis, and targeted therapies of neuroendocrine neoplasms (NENs) have drastically advanced in the past decade. Gastroenteropancreatic (GEP) NENs originate from the enteroendocrine cells of the embryonic gut which share common endocrine and neural differentiation factors. Most NENs are well-differentiated, and slow growing. Specific neuroendocrine biomarkers that are used in the diagnosis of functional NENs include insulin, glucagon, vasoactive intestinal polypeptide, gastrin, somatostatin, adrenocorticotropin, growth hormone releasing hormone, parathyroid hormone-related peptide, serotonin, histamine, and 5-hydroxy indole acetic acid (5-HIAA). Biomarkers such as pancreatic polypeptide, human chorionic gonadotrophin subunits, neurotensin, ghrelin, and calcitonin are used in the diagnosis of non-functional NENs. 5-HIAA levels correlate with tumour burden, prognosis and development of carcinoid heart disease and mesenteric fibrosis, however several diseases, medications and edible products can falsely elevate the 5-HIAA levels. Organ-specific transcription factors are useful in the differential diagnosis of metastasis from an unknown primary of well-differentiated NENs. Emerging novel biomarkers include circulating tumour cells, circulating tumour DNA, circulating micro-RNAs, and neuroendocrine neoplasms test (NETest) (simultaneous measurement of 51 neuroendocrine-specific marker genes in the peripheral blood). NETest has high sensitivity (85%-98%) and specificity (93%-97%) for the detection of gastrointestinal NENs, and is useful for monitoring treatment response, recurrence, and prognosis. In terms of management, surgery, radiofrequency ablation, symptom control with medications, chemotherapy and molecular targeted therapies are all considered as options. Surgery is the mainstay of treatment, but depends on factors including age of the individual, location, stage, grade, functional status, and the heredity of the tumour (sporadic vs inherited). Medical management is helpful to alleviate the symptoms, manage inoperable lesions, suppress postoperative tumour growth, and manage recurrences. Several molecular-targeted therapies are considered second line to somatostatin analogues. This review is a clinical update on the pathophysiological aspects, diagnostic algorithm, and management of GEP NENs.
Collapse
Affiliation(s)
- Cornelius J Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Mayuri Agarwal
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Nisha Nigil Haroon
- Department of Endocrinology and Internal Medicine, Northern Ontario School of Medicine, Sudbury P3E 2C6, Ontario, Canada
| | - Annu Susan George
- Department of Medical Oncology, VPS Lakeshore Hospital, Cochin 682040, Kerala, India
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, PR2 9HT, Preston, The University of Manchester, Oxford Road M13 9PL, Manchester Metropolitan University, All Saints Building M15 6BH, Manchester, United Kingdom
| |
Collapse
|
41
|
Laskaratos FM, Davar J, Toumpanakis C. Carcinoid Heart Disease: a Review. Curr Oncol Rep 2021; 23:48. [PMID: 33725214 DOI: 10.1007/s11912-021-01031-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The development of carcinoid heart disease (CHD) is a fibrotic complication of neuroendocrine neoplasms (NEN) which is associated with a poor prognosis. This review aims to summarise the clinical features, investigations and management of this condition. RECENT FINDINGS CHD can affect up to 50% of NET patients with carcinoid syndrome. However, it is often not screened for appropriately and recognised late when patients become symptomatic. A screening strategy with biomarkers and multimodality imaging is necessary for early recognition. Management by an experienced multidisciplinary team with appropriate medical therapeutic strategies and where indicated surgical intervention is needed to optimise clinical outcomes. CHD is a poor prognostic factor, but recently, outcomes have improved due to the multidisciplinary approach and centralised care of CHD-NET patients.
Collapse
Affiliation(s)
| | - Joseph Davar
- Carcinoid Heart Disease Clinic, Royal Free Hospital, London, UK
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, Royal Free Hospital, London, UK.
| |
Collapse
|
42
|
Sousa D, Rocha F, Baptista B, Horta AB. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia With Progression to Neuroendocrine Tumor. Cureus 2021; 13:e13297. [PMID: 33738149 PMCID: PMC7958798 DOI: 10.7759/cureus.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a parenchymal lung disease characterized by a proliferation of neuroendocrine cells in the bronchial wall, with possible local invasion and occasional development of tumorlets. It is considered to be a precursor lesion as it can progress to neuroendocrine tumors (NETs). At presentation, approximately one-half of patients with DIPNECH have a synchronous diagnosis of NET. Here, we present the case of a 95-year-old woman with progressive exertional dyspnea. She was found to have an obstructive airway syndrome and long-lasting progressive bilateral pulmonary nodules, with a distribution and growth pattern suggestive of DIPNECH, as well as possible progression to NET in the larger lesions. A transthoracic needle aspiration biopsy of a pulmonary nodule was performed, confirming the diagnosis of NET, evolving from DIPNECH.
Collapse
Affiliation(s)
- Débora Sousa
- Internal Medicine Department, Hospital da Luz Lisboa, Lisbon, PRT
| | - Filipa Rocha
- Internal Medicine Department, Hospital da Luz Lisboa, Lisbon, PRT
| | | | | |
Collapse
|
43
|
Timing of peptide receptor radiotargeted therapy in relation to cardiac valve surgery for carcinoid heart disease in patients with neuroendocrine metastases and cardiac syndrome. A single-centre study from a centre of excellence. Nucl Med Commun 2021; 41:575-581. [PMID: 32371675 DOI: 10.1097/mnm.0000000000001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Perioperative mortality of patients who undergo heart valve surgery for carcinoid heart valve disease has been observed to be high (5%-10%). We investigated whether peptide receptor radiotherapy with lutetium-177 dotatate can be used safely in patients with neuroendocrine neoplasm carcinoid heart valve disease and if there is associated survival advantage by reducing overall exposure of the valves to high doses of vasoactive peptides. METHOD Retrospective case notes review was performed on 18 neuroendocrine neoplasm patients (mean 60 years), who underwent heart valve surgery between 2003 and 2017 for carcinoid heart valve disease, 9 of whom received peptide receptor radiotherapy in addition to surgery. RESULTS All patients were treated with somatostatin receptor antagonists and underwent cardiac valvular surgery (mean two valves replaced) and three benefitted from additional coronary bypass grafting. Nine patients underwent surgery alone: in this group, the time from surgery to progression was 14 months (mean; SD 13.5 months). Nine were treated with peptide receptor radiotherapy in addition to surgery. Six underwent surgery with peptide receptor radiotherapy on progression. Time to progression from surgery to first peptide receptor radiotherapy was mean 25.1 months (SD 23.6 months). No patients developed peritreatment cardiac complications. There were no deaths within the 30-day postoperative period. Average time from surgery to last follow-up/death was 41 months (6-79) in the surgery + lutetium group and in the surgery only group 17 months (1-24). Nine patients died, five in the surgery + lutetium group and four in the surgery only group, all at greater than 1-year postsurgery. DISCUSSION Peptide receptor radiotherapy is safe in the setting of Carcinoid valvular heart disease in patients with controlled heart failure, PPRT can be use in the pre- and post-valve surgery period. There appears to be a survival benefit of having peptide receptor radiotherapy. Further evidence for peptide receptor radiotherapy in the neoadjuvant setting prior to cardiothoracic surgery is required.
Collapse
|
44
|
Walsh E, Steeds R, Rooney S, Santo K. Quadruple valve replacement for patients with carcinoid heart disease. Indian J Thorac Cardiovasc Surg 2021; 37:431-433. [PMID: 34220026 DOI: 10.1007/s12055-020-00949-6] [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: 10/10/2019] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 10/22/2022] Open
Abstract
We report two cases of patients with carcinoid heart disease affecting all four valves. All four of the valves showed signs of regurgitation and were replaced using biological valves. Left-sided involvement is uncommon (5-10%), but can occur in the absence of an intracardiac shunt. Quadruple valve replacement in symptomatic patients can result in functional improvement with acceptable risks.
Collapse
Affiliation(s)
| | - Rick Steeds
- Queen Elizabeth Hospital, Birmingham, England
| | | | | |
Collapse
|
45
|
Buchanan-Hughes A, Pashley A, Feuilly M, Marteau F, Pritchard DM, Singh S. Carcinoid Heart Disease: Prognostic Value of 5-Hydroxyindoleacetic Acid Levels and Impact on Survival: A Systematic Literature Review. Neuroendocrinology 2021; 111:1-15. [PMID: 32097914 DOI: 10.1159/000506744] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Carcinoid heart disease (CHD) can develop in patients with carcinoid syndrome (CS), itself caused by overproduction of hormones and other products from some neuroendocrine tumours. The most common hormone is serotonin, detected as high 5-hydroxyindoleacetic acid (5-HIAA). This systematic literature review summarises current literature on the impact of CHD on survival, and the relationship between 5-HIAA levels and CHD development, progression, and mortality. METHODS MEDLINE, Embase, Cochrane databases, and grey literature were searched using terms for CHD, 5-HIAA, disease progression, and mortality/survival. Eligible articles were non-interventional and included patients with CS and predefined CHD and 5-HIAA outcomes. RESULTS Publications reporting on 31 studies were included. The number and disease states of patients varied between studies. Estimates of CHD prevalence and incidence among patients with a diagnosis/symptoms indicative of CS were 3-65% and 3-42%, respectively. Most studies evaluating survival found significantly higher mortality rates among patients with versus without CHD. Patients with CHD reportedly had higher 5-HIAA levels; median urinary levels in patients with versus without CHD were 266-1,381 versus 67.5-575 µmol/24 h. Higher 5-HIAA levels were also found to correlate with disease progression (median progression/worsening-associated levels: 791-2,247 µmol/24 h) and increased odds of death (7% with every 100 nmol/L increase). CONCLUSIONS Despite the heterogeneity of studies, the data indicate that CHD reduces survival, and higher 5-HIAA levels are associated with CHD development, disease progression, and increased risk of mortality; 5-HIAA levels should be carefully managed in these patients.
Collapse
|
46
|
Tanaka H, Uema D, Rego JFM, Weschenfelder RF, D'Agustini N, Filho DRR, O'Connor JM, Luca R, Nuñez JER, de Barros E Silva MJ, Riechelmann RP. Health resource utilisation by patients with neuroendocrine tumours with or without carcinoid heart disease: a multinational study. Ecancermedicalscience 2020; 14:1141. [PMID: 33343700 PMCID: PMC7738266 DOI: 10.3332/ecancer.2020.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background Carcinoid heart disease (CHD) is a rare and severe complication from carcinoid syndrome which may be associated with high health resource utilisation (HRU). We aimed to compare HRU between patients with and without CHD. Methods Multicentre retrospective study of 137 consecutive patients with neuroendocrine tumours (NET) and elevated urinary 5-hydroxyindoleacetic acid treated in seven large hospitals in Latin America. We used the chi-squared test for binary variables and the Mann–Whitney test for quantitative correlations. Variables were entered into a multivariable linear regression model for higher HRU. Results One-third of the patients had (45) had CHD. Patients with CHD had significantly more emergency visits and echocardiograms as compared to patients without CHD. In the bivariate models, CHD (R2 = 0.61, p = 0.01), private health system (R2 = 0.63, p = 0.02) and simultaneous cardiovascular comorbidities (R2 = 0.61, p = 0.04) were associated with a higher HRU. The multivariate model pointed out the accumulated effect of variables on HRU (R2 = 0.2, p < 0.01). Conclusions NET patients with CHD present higher HRU independently of other clinical factors or health system. Effectively treating carcinoid syndrome, and likely delaying the onset of CHD, may potentially reduce the amount of HRU by these patients.
Collapse
Affiliation(s)
- Hugo Tanaka
- Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo 01509-900, Brazil
| | - Deise Uema
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden
| | | | | | | | | | - Juan M O'Connor
- Hospital de Gastroenterología Bonorino Udaondo, C1264AAA Buenos Aires, Argentina
| | - Romina Luca
- Hospital de Gastroenterología Bonorino Udaondo, C1264AAA Buenos Aires, Argentina
| | | | | | - Rachel P Riechelmann
- Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo 01509-900, Brazil
| |
Collapse
|
47
|
Dherange P, Telles N, Modi K. Flow-driven right-to-left cardiac shunting in a patient with carcinoid heart disease and patent foramen ovale without elevated right atrial pressure: a case report and literature review. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33442599 PMCID: PMC7793043 DOI: 10.1093/ehjcr/ytaa301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/10/2018] [Accepted: 08/06/2020] [Indexed: 11/14/2022]
Abstract
Background Carcinoid heart disease is present in approximately 20% of the patients with carcinoid syndrome and is associated with poor prognosis. It usually manifests with right-sided valvular involvement including tricuspid insufficiency and pulmonary stenosis. Patent foramen ovale (PFO) is present in approximately 50% of the patients with carcinoid heart disease which is twice higher than the general population. Right-to-left shunting through a PFO can occur either due to higher right atrial pressure than left (pressure-driven) or when the venous flow is directed towards the PFO (flow-driven) in the setting of normal intracardiac pressures. We report a rare case of flow-driven right-to-left atrial shunting via PFO in a patient with carcinoid heart disease. Case summary A 54-year-old male with a metastatic neuroendocrine tumour to liver presented with progressive shortness of breath for 5 months. Patient was found to be hypoxic with oxygen saturation of 78% and examination revealed a holosystolic murmur. Arterial blood gas showed oxygen tension of 43 mmHg. A transthoracic and transoesophageal echocardiogram showed aneurysmal inter-atrial septum with a PFO, severe tricuspid regurgitation directed anteriorly towards the inter-atrial septum leading to a marked right-to-left shunt. Right heart catheterization showed right atrial pressure of 8 mmHg, mean pulmonary artery pressure of 12 mmHg, and normal oxygen saturations in the right atrium, right ventricle, and pulmonary arteries. The patient then underwent closure of the PFO along with tricuspid valve and pulmonary valve replacement at an experienced cardiovascular surgical centre and has been asymptomatic since. Conclusion Right-to-left shunting through a PFO in patients with normal right atrial pressure can be successfully treated with closure of the PFO. Thus, understanding the mechanism of intracardiac shunts is important to accurately diagnose and treat this rare and fatal condition.
Collapse
Affiliation(s)
- Parinita Dherange
- Department of Cardiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Nelson Telles
- Department of Cardiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Kalgi Modi
- Department of Cardiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| |
Collapse
|
48
|
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.
Collapse
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
| |
Collapse
|
49
|
Khatiwada S, Boro H, Farooqui FA, Alam S. Endocrine causes of heart failure: A clinical primer for cardiologists. Indian Heart J 2020; 73:14-21. [PMID: 33714404 PMCID: PMC7961238 DOI: 10.1016/j.ihj.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/30/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Heart failure (HF) may be a presenting manifestation of a few endocrine disorders and should be considered in evaluation of heart failure causes. This clinically oriented review is an attempt to highlight the protean manifestations of heart failure in endocrine diseases which could present either as acute or chronic heart failure. Acute heart failure manifests as hypertensive crisis, Takotsubo syndrome, or as tachy/brady cardiomyopathies. Chronic heart failure could masquerade with features of hyperdynamic heart failure, or hypertrophic, restrictive or dilated cardiomyopathy. Rarely constrictive features or resistant heart failure could be the presenting feature. Isolated presentation as pulmonary hypertension and right heart failure are also documented. Good history-taking and physical examination with targeted investigations will help in the timely management for reversing the pathophysiology to a significant extent by appropriated management.
Collapse
Affiliation(s)
- Saurav Khatiwada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Hiya Boro
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Faraz Ahmed Farooqui
- Department of Cardiology, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, 124001, Haryana, India
| | - Sarah Alam
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
50
|
Bell J, Alhudairy M, Kazakova V, Johnstone M, Tsao L. Right and Left-Sided Carcinoid Heart Disease in the Setting of Selective Serotonin Reuptake Inhibitor Use. JACC Case Rep 2020; 2:1841-1844. [PMID: 33106792 PMCID: PMC7577728 DOI: 10.1016/j.jaccas.2020.07.060] [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: 02/20/2020] [Revised: 05/29/2020] [Accepted: 07/07/2020] [Indexed: 12/30/2022]
Abstract
Carcinoid heart disease is a complication of carcinoid syndrome. The role of selective serotonin reuptake inhibitors in carcinoid heart disease is unclear. We present a case of refractory heart failure due to right- and left-sided carcinoid heart disease in the setting of selective serotonin reuptake inhibitor use despite remission of carcinoid syndrome. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Jennifer Bell
- Division of Cardiovascular Medicine, St. Elizabeth's Medical Center, Brighton, Massachusetts
| | - Maad Alhudairy
- Department of Medicine, St. Elizabeth's Medical Center, Brighton, Massachusetts
| | - Vera Kazakova
- Department of Medicine, St. Elizabeth's Medical Center, Brighton, Massachusetts
| | - Michael Johnstone
- Division of Cardiovascular Medicine, St. Elizabeth's Medical Center, Brighton, Massachusetts
| | - Lana Tsao
- Division of Cardiovascular Medicine, St. Elizabeth's Medical Center, Brighton, Massachusetts
| |
Collapse
|