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European Heart Journal 1995 16(2):263-268;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Cardiac manifestations in mid-gut carcinoid disease

M. B. JACOBSEN, S. NITTER-HAUGE, P. E. BRYDE and L. E. HANSSEN

Medical Departments A and B, Rikshospitalet, University of Oslo Norway

Received 21 March 1994; revised 18 July 1994; accepted 10 August 1994.

Correspondence: Morten Bj. Jacobsen MD, Medical Dept A, Rikshopitalet, N-0027 Oslo, Norway.

Abstract

The extent of heart disease and its relationship to the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), was studied with M-mode, 2D and Doppler echocardiography in 42 consecutive patients, 30 females and 12 males, median age 63 (range 23–75) years with histologically verified mid-gut tumour, liver metastases and 24-h urinary 5-HIAA excretion above 47 µmol. 24h–1.

All patients had normal left ventricular ejection fractions, median 65% (interquartile range (IQR) 54–74%). Moderate to severe tricuspid regurgitation (TR) was diagnosed in 22 patients (59%); mitral or aortic regurgitation was found in nine (24%) and six (16%) patients, respectively. The mitral flow peak early (E) on late (A) velocity ratio was significantly decreased compared to age-matched normal subjects. The group of patients with 5-HIAA excretion exceeding 1000µmol. 24h–1 contained significantly more patients with severe TR than those with a lower excretion.

The decrease in the El A ratio may indicate reduced left ventricular compliance, possibly secondary to fibrous changes similar to those seen intra-abdominally and in the right side of the heart. As serotonin is degraded in the lung circulation, other mediators such as tachykinins and cytokines (PDGF) may be involved.

Key Words: Carcinoid tumours • diastolic function • left ventricular filling • myocardial fibrosis • serotonin • valvular heart disease


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