Abstract 14519: A Prospective Study of Risk Factors for the Development and Progression of Carcinoid Heart Disease
Objective: The development of valvular heart disease in patients with carcinoid syndrome is a significant cause of mortality and morbidity in these patients. We sought to identify potentially modifiable risk factors for development and/or progression of carcinoid heart disease.
Methods: 252 patients with carcinoid syndrome were prospectively followed up with serial echocardiograms at 6 monthly intervals. Clinical characteristics (diarrhoea and flushing), biochemical markers (5-hydroxyindolacetic acid (5-HIAA) and Chromogranin A) and radiological markers (liver metastases size) were measured at the same intervals. An echocardiographic scoring system was applied. Patients were defined as having progression of carcinoid heart disease if the echocardiographic score increased by 25% or more.
Results: After a median follow up of 29 months, 44 patients either developed carcinoid heart disease or had progression of existing valvular dysfunction. At the time of progression of carcinoid heart disease, compared to the previous 6 months, there was a significant increase in median levels of 5-HIAA (791 umols/24hr vs 460.5 umols/24hr) and flushing episodes (4.5 episodes per day vs 2 episodes per day). Independent predictors of the progression of carcinoid heart disease were a 5-HIAA greater than 300 umols/24hr and greater than 3 episodes of flushing per day. 5HIAA levels of ≥300 to 599, 600–899 and >900 umols/24 hour conferred 2.74, 3.16 and 3.40 times the risk of progression of carcinoid heart disease, respectively.
Conclusion: A 5-HIAA > 300 umol/24 hours and daily flushing episodes greater than 3 are predictors of the development and progression of carcinoid heart disease.
- © 2010 by American Heart Association, Inc.