PMID- 12074037
OWN - NLM
STAT- MEDLINE
DCOM- 20020711
LR  - 20151119
IS  - 0300-2977 (Print)
IS  - 0300-2977 (Linking)
VI  - 60
IP  - 1
DP  - 2002 Mar
TI  - Cardiovascular abnormalities in patients with a carcinoid syndrome.
PG  - 10-6
AB  - BACKGROUND: Heart failure is an important reason for morbidity and mortality in 
      patients with carcinoid. Carcinoid heart disease is caused by increased levels of 
      circulating serotonin. Because carcinoids also produce catecholamines, we 
      evaluated cardiovascular manifestations of autonomic dysfunction in patients with 
      a carcinoid syndrome. METHODS: Twenty patients with a midgut carcinoid, who had a 
      carcinoid syndrome with a median duration of 72 months, and markedly elevated 
      urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion were studied. RESULTS: Ten 
      patients had no symptoms of heart failure, i.e. New York Heart Association (NYHA) 
      functional class I, 6 had class II, and 4 class III heart failure. Transthoracic 
      echocardiography (TTE) showed right-sided valvular abnormalities in 13 of 19 
      evaluable patients (mild n=8, severe n=5). Fourteen of the 20 patients (70%) had 
      an elevated concentration of plasma N-terminal atrial natriuretic peptide 
      (N-ANP), which correlated with NYHA class, TTE abnormalities, and increased 
      urinary metanephrine excretion. Heart rate variability (HRV) parameters, in 
      particular those associated with increased sympathetic activity (low frequency 
      power, p=0.002 versus healthy individuals), were impaired but were independent of 
      NYHA class and TTE findings and correlated with urinary metanephrine excretion 
      (r=-0.49, p<0.05). CONCLUSION: In these 20 carcinoid patients with substantial 
      secretory activity of the tumour, overt cardiac morphological changes were 
      present in a minority of patients. However, N-ANP values and HRV profile were 
      markedly abnormal, and related to enhanced urinary excretion of catecholamine and 
      metabolites, suggesting autonomic derangement. These abnormalities possibly 
      herald the development of more severe cardiac dysfunction and may be indicative 
      of the need for preventive drug treatment.
FAU - Meijer, W C
AU  - Meijer WC
AD  - University Hospital Groningen, Department of Medical Oncology, The Netherlands.
FAU - van Veldhuisen, D J
AU  - van Veldhuisen DJ
FAU - Kema, I P
AU  - Kema IP
FAU - Van den Berg, M P
AU  - Van den Berg MP
FAU - Boomsma, F
AU  - Boomsma F
FAU - Willemse, P H B
AU  - Willemse PH
FAU - De Vries, E G E
AU  - De Vries EG
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Neth J Med
JT  - The Netherlands journal of medicine
JID - 0356133
RN  - 0 (Biomarkers)
RN  - 333DO1RDJY (Serotonin)
SB  - IM
MH  - Adult
MH  - Age Distribution
MH  - Aged
MH  - Biomarkers/analysis
MH  - Blood Chemical Analysis
MH  - Carcinoid Heart Disease/*diagnosis/etiology/mortality
MH  - Carcinoid Tumor/complications/diagnosis
MH  - Echocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Probability
MH  - Prognosis
MH  - Prospective Studies
MH  - Regression Analysis
MH  - Risk Assessment
MH  - Risk Factors
MH  - Sensitivity and Specificity
MH  - Serotonin/*blood/*urine
MH  - Severity of Illness Index
MH  - Sex Distribution
MH  - Survival Rate
EDAT- 2002/06/21 10:00
MHDA- 2002/07/12 10:01
CRDT- 2002/06/21 10:00
PHST- 2002/06/21 10:00 [pubmed]
PHST- 2002/07/12 10:01 [medline]
PHST- 2002/06/21 10:00 [entrez]
PST - ppublish
SO  - Neth J Med. 2002 Mar;60(1):10-6.