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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.
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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
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Grundmann E, Curioni-Fontecedro A, Christ E, Siebenhüner AR. Outcome of carcinoid heart syndrome in patients enrolled in the SwissNet cohort. BMC Cancer 2023; 23:338. [PMID: 37055717 PMCID: PMC10099832 DOI: 10.1186/s12885-023-10739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/14/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Carcinoid heart disease is a rare disease which develops in patients with functional neuroendocrine tumors in an advanced tumor state. Patients diagnosed with carcinoid heart disease have a poor longtime prognosis with respect to morbidity and mortality and long-term data on patient outcomes are lacking. METHODS AND RESULTS In this retrospective study, we analyzed outcomes of 23 patients with carcinoid heart disease enrolled into the SwissNet database. We observed that early diagnosis with echocardiographic surveillance of carcinoid heart disease during the course of the neuroendocrine tumor disease was beneficial to overall survival of patients. CONCLUSION Through nationwide patient enrollment, the SwissNet registry is a powerful data tool to identify, follow-up and evaluate long-term patient outcomes in patients with rare neuroendocrine tumor driven pathologies including carcinoid heart syndrome with observational methods enabling better therapy optimization to improve patient`s long-term perspectives and survival. In line with the current ESMO recommendations, our data proposes that heart echocardiography should be included as part of the general physical assessment in patients with newly diagnosed NET.
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Affiliation(s)
- Eva Grundmann
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland
| | - Alessandra Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland
| | - Emanuel Christ
- Department of Endocrinology, Diabetes, and Metabolism, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Alexander R Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland.
- Clinic of Medical Oncology and Hematology, Hirslanden Zurich AG, Witellikerstrasse 40, Zurich, CH-8032, Switzerland.
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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.
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(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]
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Alizadehasl A, Galeshi B, Peighambari M, Pouraliakbar H, Moradian M, Hashemi A. A forgotten diagnosis in right heart failure: A case report and literature review. Clin Case Rep 2021; 9:2040-2047. [PMID: 33936637 PMCID: PMC8077272 DOI: 10.1002/ccr3.3938] [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: 10/17/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 11/06/2022] Open
Abstract
Carcinoid heart disease is a well-known complication of carcinoid syndrome that affects morbidity and mortality. Carcinoid heart disease may be asymptomatic in the early stages; therefore, patients with carcinoid syndrome should be screened to prevent misdiagnosis.
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Affiliation(s)
- Azin Alizadehasl
- Cardio‐Oncology Research CenterRajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Bahar Galeshi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Mehdi Peighambari
- Heart Valve Disease Research CenterRajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Maryam Moradian
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
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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.
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Affiliation(s)
| | - Rick Steeds
- Queen Elizabeth Hospital, Birmingham, England
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Gade AK, Olariu E, Douthit NT. Carcinoid Syndrome: A Review. Cureus 2020; 12:e7186. [PMID: 32257725 PMCID: PMC7124884 DOI: 10.7759/cureus.7186] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
Carcinoid syndrome (CS) is a paraneoplastic syndrome caused by the release of serotonin and other substances from well-differentiated neuroendocrine tumors (NETs). The hallmark symptoms of carcinoid syndrome are flushing and diarrhea; atypical signs and symptoms can include wheezing, abdominal pain, valvular heart disease, telangiectasias, pellagra, and the complications of mesenteric fibrosis, including ureteral obstruction, bowel obstruction, and bowel ischemia. These symptoms are mediated by the release of serotonin (5-HT), histamine, kallikrein, prostaglandins, and tachykinins. The diagnosis of CS requires these symptoms and corresponding elevations in lab tests. Treatment options include surgery and medical management with somatostatin analogs.
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Affiliation(s)
- Ajay K Gade
- Internal Medicine, Brookwood Baptist Medical Center, Birmingham, USA
| | - Eva Olariu
- Internal Medicine, Brookwood Baptist Health, Birmingham, USA
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Ram P, Penalver JL, Lo KBU, Rangaswami J, Pressman GS. Carcinoid Heart Disease: Review of Current Knowledge. Tex Heart Inst J 2019. [PMID: 30833833 DOI: 10.14503/thij-17-65623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Carcinoid heart disease is the collective term for all cardiac manifestations in patients who have carcinoid syndrome. Carcinoid heart disease has a multifactorial pathophysiology, and the right side of the heart is usually involved. Symptoms and signs vary depending upon the affected cardiac components; most typical is right-sided heart failure secondary to diseased tricuspid and pulmonary valves. Despite no single ideal diagnostic test, strong suspicion, coupled with serologic and imaging results, usually enables diagnosis. Advances in imaging, such as speckle-tracking echocardiography and cardiac magnetic resonance, have improved the diagnostic yield. Treatment is challenging, warrants a multidisciplinary approach, and can be medical or surgical depending on the cardiac manifestations. Investigators are exploring the therapeutic use of monoclonal antibodies and new somatostatin analogues. In this review, we cover current knowledge about the pathophysiology, diagnosis, and treatment of carcinoid heart disease.
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Ram P, Penalver JL, Lo KBU, Rangaswami J, Pressman GS. Carcinoid Heart Disease: Review of Current Knowledge. Tex Heart Inst J 2019; 46:21-27. [PMID: 30833833 DOI: 10.14503/thij-17-6562] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Carcinoid heart disease is the collective term for all cardiac manifestations in patients who have carcinoid syndrome. Carcinoid heart disease has a multifactorial pathophysiology, and the right side of the heart is usually involved. Symptoms and signs vary depending upon the affected cardiac components; most typical is right-sided heart failure secondary to diseased tricuspid and pulmonary valves. Despite no single ideal diagnostic test, strong suspicion, coupled with serologic and imaging results, usually enables diagnosis. Advances in imaging, such as speckle-tracking echocardiography and cardiac magnetic resonance, have improved the diagnostic yield. Treatment is challenging, warrants a multidisciplinary approach, and can be medical or surgical depending on the cardiac manifestations. Investigators are exploring the therapeutic use of monoclonal antibodies and new somatostatin analogues. In this review, we cover current knowledge about the pathophysiology, diagnosis, and treatment of carcinoid heart disease.
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Incidental Left Atrial Mass on Transesophageal Echocardiogram During Evaluation of Severe Mitral Regurgitation. CASE (PHILADELPHIA, PA.) 2019; 3:63-66. [PMID: 31049482 PMCID: PMC6479202 DOI: 10.1016/j.case.2018.10.002] [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] [Indexed: 11/23/2022]
Abstract
Primary mitral regurgitation should be further evaluated with TEE. Incidental cardiac mass on TEE is better characterized with cardiac magnetic resonance. Cardiac tumors can affect the mitral valve.
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Mujtaba SS, Clark S. Quadruple Valve Replacement for Carcinoid Heart Disease. Braz J Cardiovasc Surg 2019; 33:398-403. [PMID: 30184038 PMCID: PMC6122765 DOI: 10.21470/1678-9741-2017-0224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/26/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature. METHODS All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours. RESULTS Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases. CONCLUSION Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement.
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Affiliation(s)
- Syed Saleem Mujtaba
- Freeman Hospital Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Clark
- Freeman Hospital Newcastle, United Kingdom of Great Britain and Northern Ireland
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