High hepatic tumor burden and cardiovascular comorbidities linked to carcinoid heart disease

Mesquita, Marcella Coelho; Silva, C.A.C.; Silva, C.M.P.D.C.; Soeiro, Maria Carolina Feres de Almeida; Hajjar, Ludhmila Abrahão; Hoff, Paulo M.; Riechelmann, Rachel

doi:10.1093/annonc/mdx368.019

Cited by 1 publication

(4 citation statements)

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“…2). Several studies featured patients who were referred for echocardiography based on suspicion of CHD, implying potential selection bias [16, 20, 25, 27]. Removing these studies would decrease the highest reported CHD prevalence estimates from 65% to 57% [15], and the highest calculated crude incidence figures from 42% to 33% [17].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 19 studies reported baseline levels of urinary 5-HIAA (u5-HIAA) in patients with CHD [15-21, 25, 27-29, 31, 32, 34, 35, 40, 45-49]; of these, 13 studies also presented baseline levels of u5-HIAA in patients without CHD (Table 4) [15-18, 20, 21, 25, 27-29, 31, 32, 34, 35, 40].…”

Section: Resultsmentioning

confidence: 99%

“…4; variability within individual studies is shown in Table 4). Following conversion to µmol/24 h for studies using mg/24 h, the mean and median baseline levels of u5-HIAA in patients with versus without CHD were 319–2,009 versus 175–685 µmol/24 h, and 266–1,381 versus 67.5–575 µmol/24 h, respectively [15-18, 20, 21, 25, 27-29, 31, 32, 35, 40, 45-49]. Two studies presented their u5-HIAA measurements in mmol or µmol per mole of creatinine and, as such, could not be directly compared [19, 34].…”

Section: Resultsmentioning

confidence: 99%

“…The large range of CHD incidence estimates could also be a result of variation across the study populations. Three studies investigated patients who were referred for echocardiographic evaluation due to suspicion of CHD [16, 20, 25, 27], and reported incidence estimates of 56% [16], 49% [20], and 40% [25, 27], respectively. This is higher than the median CHD incidence of 24% taken across all the identified studies and is likely to be due to selection bias.…”

Section: Discussionmentioning

confidence: 99%

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Carcinoid Heart Disease: Prognostic Value of 5-Hydroxyindoleacetic Acid Levels and Impact on Survival: A Systematic Literature Review

et al. 2020

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Background: Carcinoid heart disease (CHD) can develop in patients with carcinoid syndrome (CS), itself caused by overproduction of hormones and other products from some neuroendocrine tumours. The most common hormone is serotonin, detected as high 5-hydroxyindoleacetic acid (5-HIAA). This systematic literature review summarises current literature on the impact of CHD on survival, and the relationship between 5-HIAA levels and CHD development, progression, and mortality. Methods: MEDLINE, Embase, Cochrane databases, and grey literature were searched using terms for CHD, 5-HIAA, disease progression, and mortality/survival. Eligible articles were non-interventional and included patients with CS and predefined CHD and 5-HIAA outcomes. Results: Publications reporting on 31 studies were included. The number and disease states of patients varied between studies. Estimates of CHD prevalence and incidence among patients with a diagnosis/symptoms indicative of CS were 3–65% and 3–42%, respectively. Most studies evaluating survival found significantly higher mortality rates among patients with versus without CHD. Patients with CHD reportedly had higher 5-HIAA levels; median urinary levels in patients with versus without CHD were 266–1,381 versus 67.5–575 µmol/24 h. Higher 5-HIAA levels were also found to correlate with disease progression (median progression/worsening-associated levels: 791–2,247 µmol/24 h) and increased odds of death (7% with every 100 nmol/L increase). Conclusions: Despite the heterogeneity of studies, the data indicate that CHD reduces survival, and higher 5-HIAA levels are associated with CHD development, disease progression, and increased risk of mortality; 5-HIAA levels should be carefully managed in these patients.

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