Abstract 11805: Which Echocardiographic Scoring System for Carcinoid Heart Disease?

Abstract

Introduction & hypothesis: Carcinoid heart disease (CHD) is a complication of carcinoid syndrome. Multiple CHD scoring systems have been developed with little evaluation of their validity, resulting in a lack of consensus over how to most accurately quantify CHD. We tested the hypothesis that there is a single best scoring system for the detection and evaluation of CHD by applying and comparing them in our population of patients with metastatic carcinoid disease attending a specialist neuroendocrine clinic in a university hospital.

Methods: Medline and PubMed databases were searched with the terms ‘carcinoid heart disease’, ‘score’ and ‘scoring system’, identifying five scores. CHD was defined by a thickened and regurgitant right-sided valve. Subjects underwent transthoracic echocardiography (GE Vivid Q machine) performed by a single experienced operator. An additional score was calculated, based on right-sided valve anatomy, mobility and function, right atrial size and right ventricular size and function.

Results: 52 patients were studied. 18 patients (35%) had echocardiographic evidence of CHD. There was no significant difference between those with/without CHD in terms of age (65 years vs 63 years [p=0.38]), sex (50% male vs 55% male [p=0.70]), presence of carcinoid syndrome (65% vs 50% [p=0.30]) or duration of disease (58 months vs 34 months [p=0.77]). The scores correlated well with each other (Spearman r = 0.69 - 0.92). There was no significant difference between the methods in their ability to predict CHD. The additional scoring system incorporating what we considered to be the most clinically relevant elements of all the scores did not have incremental discriminatory ability for detection of CHD.

Conclusion: All scores were able to discriminate highly between those with/without CHD with no single score out-performing the others. Choice of score at individual centres is likely to be informed by familiarity and ease of use rather than predictive value.