Left Ventricular Structural and Functional Alterations in Patients With Pheochromocytoma/Paraganglioma Before and After Surgery

Dobrowolski, Piotr; Januszewicz, Andrzej; Klisiewicz, Anna; Gosk-Przybylek, M.; Pęczkowska, Mariola; Kabat, Marek; Kwapiszewska, Aleksandra; Warchoł-Celińska, Ewa; Ambroziak, Urszula; Doroszko, Adrian; Toutounchi, Sadegh; Gałązka, Zbigniew; Bednarczuk, Tomasz; Górnicka, Barbara; Januszewicz, Magdalena; Hoffmań, Piotr; Lenders, Jacques W.M.; Eisenhofer, Graeme; Prejbisz, Aleksander

doi:10.1016/j.jcmg.2020.07.017

Cited by 20 publications

(24 citation statements)

References 26 publications

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“…Our study confirmed previous results that normalization of catecholamine in patients with PHEO leads to a positive LV remodelling ( 8 ) and an improvement in the longitudinal LV function and deformation represented by GLS ( 15 ). Moreover, we primarily focused on the evaluation of regional LS in individual LV segments and the effect of adrenalectomy on their final function.…”

Section: Discussionsupporting

confidence: 92%

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Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study

Kvasnička

Petrák

Zelinka

et al. 2021

Endocrine Connections

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Background Pheochromocytomas (PHEO) are tumours with the ability to produce, metabolize and secrete catecholamines. Catecholamines overproduction leads to the decrease of longitudinal function of the left ventricle (LV) measured by speckle-tracking echocardiography. Patients with PHEO have a lower magnitude of global longitudinal strain (GLS) than patients with essential hypertension. GLS normalization is expected after resolution of catecholamine overproduction. Methods Twenty-four patients (14 females and 10 males) with a recent diagnosis of PHEO have been examined before and 1 year after adrenalectomy. An echocardiographic examination including speckle-tracking analysis with the evaluation of GLS and regional longitudinal strain (LS) in defined groups of LV segments (basal, mid-ventricular and apical) was performed. Results One year after adrenalectomy, the magnitude of GLS increased (−14.3 ± 1.8 to −17.7 ± 1.6%; P < 0.001). When evaluating the regional LS, the most significant increase in the differences was evident in the apical segment compared to mid-ventricular and basal segments of LV (−5.4 ± 5.0 vs −1.9 ± 2.7 vs −1.6 ± 3.8; P < 0.01). Conclusions In patients with PHEO, adrenalectomy leads to an improvement of subclinical LV dysfunction represented by the increasing magnitude of GLS, which is the most noticeable in apical segments of LV.

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Section: Discussionsupporting

confidence: 92%

“…This advantage of GLS over EF in patients with PHEO has already been confirmed by our previous study ( 14 ). Further studies have confirmed the improvement of GLS after surgical removal of PHEO ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 76%

Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study

Kvasnička

Petrák

Zelinka

et al. 2021

Endocrine Connections

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“…Independent support for this concept is provided by another study that has linked epinephrine-producing tumours with more severe cardiac changes than PPGLs that produce only norepinephrine. 33 Also in line with other observations, 34,35 higher concentrations of catecholamines may alter body composition through their effects on metabolism of skeletal muscle and visceral fat.…”

Section: Discussionsupporting

confidence: 78%

Impact of body composition and genotype on haemodynamics during surgery for pheochromocytoma and paraganglioma

Pang

Jiang

et al. 2022

J cachexia sarcopenia muscle

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Background Maintaining intraoperative haemodynamic stability can reduce cardiovascular complications during surgery for pheochromocytoma and paraganglioma (PPGL). Risk factors such as tumour size and catecholamine levels are reported to predict haemodynamic responses during surgery for PPGL. We hypothesized that additional factors including body composition and genetic information could further improve prediction. Methods Consecutive patients with PPGL confirmed by surgical pathology between June 2010 and June 2019 were retrospectively included. Cross‐sectional computed tomography images at the L3 level were used to assess body composition parameters including skeletal muscle area and visceral fat area. Next‐generation sequencing was performed using a panel containing susceptibility genes of PPGL. Differences in clinical‐genetic characteristics and body composition parameters were analysed and compared in patients with and without intraoperative haemodynamic instability (HDI). Results We included 221 patients with PPGL (median age 47 [38–56] years, and 52% male). Among them, 49.8% had Cluster 2 mutations (related to kinase signalling pathways), 44.8% had sarcopenia, and 52.9% experienced intraoperative HDI. Compared with patients without HDI, more patients with HDI had Cluster 2 mutations (59.8% vs. 38.5%, P = 0.002) and less had sarcopenia (35.9% vs. 54.8%, P = 0.005). Multivariate analysis showed that urine vanillylmandelic acid ≥ 58 μmol/day (adjusted odds ratio [OR] = 1.840, 95% confidence interval [CI] = 1.012–3.347, P = 0.046), tumour size ≥ 4 cm (adjusted OR = 2.278, 95% CI = 1.242–4.180, P = 0.008), and Cluster 2 mutations (adjusted OR = 2.199, 95% CI = 1.128–4.285, P = 0.021) were independent risk factors for intraoperative HDI, while sarcopenia (adjusted OR = 0.475, 95% CI = 0.266–0.846, P = 0.012) decreased the risk. Conclusions Body composition and genotype were associated with intraoperative haemodynamics in patients with PPGL. Our results indicated that inclusion of body composition and genotype in the overall assessment of patients with PPGL helped to predict HDI during surgery, which could assist in implementing preoperative and intraoperative measures to reduce perioperative complications.

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“…Improvements in GLS have also been observed in treatment of patients with other forms of secondary hypertension. Dobrowolski and colleagues demonstrated that resection of a pheochromocytoma or paraganglioma led to improvements in LV subclinical systolic dysfunction assessed by GLS, highlighting the deleterious effects of catecholamine excess on the myocardium ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

et al. 2022

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IntroductionPrimary aldosteronism (PA) is associated with increased risk of cardiovascular events. However, treatment of PA has not been shown to improve left ventricular (LV) systolic function using the conventional assessment with LV ejection fraction (LVEF). We aim to use speckle-tracking echocardiography to assess for improvement in subclinical systolic function after treatment of PA.MethodsWe prospectively recruited 57 patients with PA, who underwent 24-h ambulatory blood pressure (BP) measurements and echocardiography, including global longitudinal strain (GLS) assessment of left ventricle, at baseline and 12 months post-treatment.ResultsAt baseline, GLS was low in 14 of 50 (28.0%) patients. On multivariable analysis, GLS was associated with diastolic BP (P = 0.038) and glomerular filtration rate (P = 0.026). GLS improved post-surgery by −2.3, 95% CI: −3.9 to −0.6, P = 0.010, and post-medications by −1.3, 95% CI: −2.6 to 0.03, P = 0.089, whereas there were no changes in LVEF in either group. Improvement in GLS was independently correlated with baseline GLS (P < 0.001) and increase in plasma renin activity (P = 0.007). Patients with post-treatment plasma renin activity ≥1 ng/ml/h had improvements in GLS (P = 0.0019), whereas patients with persistently suppressed renin had no improvement. Post-adrenalectomy, there were also improvements in LV mass index (P = 0.012), left atrial volume index (P = 0.002), and mitral E/e’ (P = 0.006), whereas it was not statistically significant in patients treated with medications.ConclusionTreatment of hyperaldosteronism is effective in improving subclinical LV systolic dysfunction. Elevation of renin levels after treatment, which reflects adequate reversal of sodium overload state, is associated with better systolic function after treatment.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03174847.

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Left Ventricular Structural and Functional Alterations in Patients With Pheochromocytoma/Paraganglioma Before and After Surgery

Cited by 20 publications

References 26 publications

Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study

Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study

Impact of body composition and genotype on haemodynamics during surgery for pheochromocytoma and paraganglioma

Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

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