Abstract 13985: In Patients with Intestinal Carcinoid Disease, Myocardial Function Deteriorates Progressively in Both Ventricles and Predicts Mortality

Abstract

Background: Cardiac fibrosis is an important complication of intestinal carcinoid disease (CD). Evaluation of myocardial function in patients with CD has focused on the right ventricle (RV) function. It has recently been suggested that the left ventricle (LV) function is also affected. Impaired myocardial function increases mortality, and we hypothesized that function by LV and RV strain could predict death in patients with intestinal CD.

Methods: 89 patients (age 61±12 years) with verified intestinal CD were examined with 2-dimensional speckle tracking echocardiography (2D-STE) at baseline. LV global longitudinal strain was calculated from a 16 segments model, and RV longitudinal strain was calculated in a 3 segments model (free wall). The patients were followed up for a period of 1252 ± 374 days. Mortality data was obtained from hospital records. Survival was calculated by the Kaplan-Meier method, and log-rank test was used to compare the survival curves. Follow up 2D-STE was done among survivors.

Results: Twenty-one patients (24%) died during follow up. LV function by global strain at baseline was significantly reduced (-17.6 ± 2.0% vs. -19.3 ± 2.6%, p=0.001) in those who died during follow up. RV function was also significantly reduced (-23.9 ± 4.6% vs. -26.6 ± 4.0%, p=0.02). By Cox regression analysis, LV and RV baseline strain were independent predictors of mortality (LV: Hazard ratio (HR) 1.17 (95% CI 1.04-1.32) (p=0.011), RV: HR 1.26 (95% CI 1.04-1.53) (p=0.018)). At follow up of survivors, myocardial strain was significantly reduced from baseline in both LV (19.6 ± 2.6% to 17.9 ± 2.5%, p<0.001) and RV (-27.1 ± 4.0% to -24.8 ± 4.9%, p=0.01) supporting biventricular involvement of this disease.

Conclusion: LV and RV myocardial strain predicted mortality in patients with intestinal CD during 3.5 years of follow up. Our findings indicate a biventricular progressive deterioration in patients with intestinal CD.