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2014 ; 111
(9
): 1703-9
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Serial surveillance of carcinoid heart disease: factors associated with
echocardiographic progression and mortality
#MMPMID25211656
Dobson R
; Burgess MI
; Valle JW
; Pritchard DM
; Vora J
; Wong C
; Chadwick C
; Keevi B
; Adaway J
; Hofmann U
; Poston GJ
; Cuthbertson DJ
Br J Cancer
2014[Oct]; 111
(9
): 1703-9
PMID25211656
show ga
BACKGROUND: Carcinoid heart disease is a complication of metastatic
neuroendocrine tumours (NETs). We sought to identify factors associated with
echocardiographic progression of carcinoid heart disease and death in patients
with metastatic NETs. METHODS: Patients with advanced non-pancreatic NETs and
documented liver metastases and/or carcinoid syndrome underwent prospective
serial clinical, biochemical, echocardiographic and radiological assessment.
Patients were categorised as carcinoid heart disease progressors, non-progressors
or deceased. Multinomial regression was used to assess the univariate association
between variables and carcinoid heart disease progression. RESULTS: One hundred
and thirty-seven patients were included. Thirteen patients (9%) were progressors,
95 (69%) non-progressors and 29 (21%) patients deceased. Baseline median levels
of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and plasma
5-hydroxyindoleacetic acid (5-HIAA) were significantly higher in the progressors.
Every 100 nmol l(-1) increase in 5-HIAA yielded a 5% greater odds of disease
progression (OR 1.05, 95% CI: 1.01, 1.09; P=0.012) and a 7% greater odds of death
(OR 1.07, 95% CI: 1.03, 1.10; P=0.001). A 100 ng l(-1) increase in NT-proBNP did
not increase the risk of progression, but did increase the risk of death by 11%.
CONCLUSIONS: The biochemical burden of disease, in particular baseline plasma
5-HIAA concentration, is independently associated with carcinoid heart disease
progression and death. Clinical and radiological factors are less useful
prognostic indicators of carcinoid heart disease progression and/or death.