Subclinical left ventricular systolic dysfunction detected by two‐dimensional speckle tracking echocardiography in patients with pheochromocytoma and paraganglioma and preserved ejection fraction

Ding, Li; Zhu, Wen; Zeng, Zheng; Li, Han Zhong; Ji, Jin; Fang, Li Gang; Sun, Jing Ping

doi:10.1111/echo.13752

Cited by 10 publications

(7 citation statements)

References 16 publications

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“…Another study retrospectively identified a relationship between secretion mode of noradrenergic phenotype and a reverse dipping status and LVH in PPGL patients [ 14 ]. A Chinese study also suggested that the 24-h urinary norepinephrine value was positively associated with the LVMI [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Hypertension and cardiac damage in pheochromocytoma and paraganglioma patients: a large-scale single-center cohort study

Yu,

Chen,

Meng

et al. 2024

BMC Cardiovasc Disord

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Background Hypertension (HT) is one of the most common manifestations in patients with catecholamine-secreting neuroendocrine tumors. Although the cardiovascular manifestations of these tumors have been described, there have been no large-scale investigations of the profile of HT and changes in cardiac structure and function that occur in patients with pheochromocytomas and paragangliomas (PPGL). Materials and methods In this study, we investigated the prevalence of HT and left ventricular remodeling (LVR) in a cohort of 598 patients who underwent surgery for PPGL at our center between January 2001 and April 2022. Information on demographics, reason for hospitalization, medical history, biochemical parameters, findings on echocardiography, and tumor characteristics were recorded. The LVR index was compared according to whether or not there was a history of HT. Results The average age was 47.07 ± 15.07 years, and 277 (46.32%) of the patients were male. A history of HT was found in 423 (70.74%) of the 598 patients. Paraganglioma was significantly more common in the group with HT (26.00% vs. 17.71%, P = 0.030) and significantly less likely to be found incidentally during a health check-up in this group (22.93% vs. 59.43%, P < 0.001). Among 365 patients with complete echocardiography data, left ventricular mass index (86.58 ± 26.70 vs. 75.80 ± 17.26, P < 0.001) and relative wall thickness (0.43 ± 0. 08 vs. 0.41 ± 0.06, P = 0.012) were significantly higher in patients with PPGL and a history of HT. The proportions with left ventricular hypertrophy (LVH) (19.40% vs. 8.25%, P = 0.011) and LVR (53.73% vs. 39.18%, P = 0.014) were also higher when there was a history of HT. After adjusting for age, gender, body mass index, alcohol consumption, smoking status, diabetes, stroke, creatinine level, tumor location, and tumor size, a history of HT was significantly correlated with LVH (odds ratio 2.71, 95% confidence interval 1.18–6.19; P = 0.018) and LVR (odds ratio 1.83, 95% confidence interval 1.11–3.03; P = 0.018). Conclusion HT is common in patients with PPGL (70.74% in this cohort). PPGL without a history of HT is more likely to be found incidentally (59.43% in our cohort). HT is associated with LVR in PPGL patients with complete echocardiography data. These patients should be observed carefully for cardiac damage, especially those with a history of HT.

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Section: Discussionmentioning

confidence: 99%

Hypertension and cardiac damage in pheochromocytoma and paraganglioma patients: a large-scale single-center cohort study

Yu,

Chen,

Meng

et al. 2024

BMC Cardiovasc Disord

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“…In another two-dimensional speckle tracking echocardiography study, the excessive release of norepinephrine in the PPGLs group was associated with an elevated LV mass and BP levels. Regarding LV function, although the EF was similar in patients with PPGLs and control patients, the LV global longitudinal strain (GLS) was decreased in patients with catecholamine-releasing tumors [20]. Comparative to subjects with essential hypertension, with similar BP levels, patients with pheochromocytoma displayed lower GLS values.…”

Section: Catecholamine-induced Cardiomyopathymentioning

confidence: 96%

A Late-Detected Paraganglioma in a Young Patient with Resistant Hypertension and Severe Aortic Regurgitation—A Case Report and Review of the Literature

Istrătoaie

Kovács²,

Manole

et al. 2023

JCM

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Background: Paraganglioma is a rare neuroendocrine tumor derived from chromaffin cells. The overproduction of catecholamines accounts for the presenting symptoms and cardiovascular complications. The clinical presentation frequently overlaps with the associated cardiac diseases, delaying the diagnosis. Multimodality imaging and a multidisciplinary team are essential for the correct diagnosis and adequate clinical management. Case Summary: A 37-year-old woman with a personal medical history of long-standing arterial hypertension and radiofrequency ablation for atrioventricular nodal reentry tachycardia presented with progressive exertional dyspnea and elevated blood pressure values, despite a comprehensive pharmacological treatment with six antihypertensive drugs. The echocardiography showed a bicuspid aortic valve and severe aortic regurgitation. The computed tomography angiography revealed a retroperitoneal space-occupying solid lesion, with imaging characteristics suggestive of a paraganglioma. The multidisciplinary team concluded that tumor resection should be completed first, followed by an aortic valve replacement if necessary. The postoperative histopathology examination confirmed the diagnosis of paraganglioma. After the successful resection of the tumor, the patient was asymptomatic, and the intervention for aortic valve replacement was delayed. Discussion: This was a rare case of a late-detected paraganglioma in a young patient with resistant hypertension overlapping the clinical presentation and management of severe aortic regurgitation. A multimodality imaging approach including transthoracic and transesophageal echocardiography, computed tomography, and magnetic resonance imaging had an emerging role in establishing the diagnosis and in guiding patient management and follow-up. The resection of paraganglioma was essential for the optimal timing of surgical correction for severe aortic regurgitation. We further reviewed various cardiovascular complications induced by pheochromocytomas and paragangliomas.

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“…Speckle tracking echocardiography is a technique by which global longitudinal and circumferential strain parameters are derived to assess the subclinical changes in LV function, reflecting myocardial fibrosis independently of hypertrophy [13]. Few studies have established a global strain pattern in PPGL patients; however, the recovery of the same following alpha blockade and surgery has not been evaluated so far [14, 15]. Our study aimed to objectively evaluate the cardiac changes in PPGL patients and their reversal following curative surgery.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Changes and Their Reversal Following Curative Surgery in Pheochromocytoma: PheoCard Prospective Cohort Study

et al. 2022

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Background Pheochromocytoma and paraganglioma (PPGL) are catecholamine producing tumors of chromaffin cell origin, known to cause varied cardiovascular manifestations from hypertension to myocardial infarction. This study sought to objectively evaluate the cardiac changes in PPGL patients and their reversal following curative surgery. Methods The PheoCard study was registered in ClinicalTrials.gov (NCT05082311) and involved 35 consecutive PPGL patients managed as per standard protocol involving alpha blockade followed by curative surgery. They underwent detailed cardiac evaluation using 2D‐echocardiography and speckle tracking echocardiography at the time of diagnosis, 7–10 days after alpha blockade, and at 7 days, 3 months, and 6 months after surgical removal. Age‐ and gender‐matched essential hypertensives and healthy individuals (10 in each group) served as two control groups. Results Patients with PPGLs had significantly higher mean blood pressure, left ventricle end‐diastolic dimension and volume (LVEDD, LVEDV), left ventricle end‐systolic volume (LVESV), septal wall thickness, LV hypertrophy, lower mean LV ejection fraction (LVEF), early diastolic mitral annular velocity (E/A), decreased amplitude of LV longitudinal strain, and increased circumferential strain (p < 0.001) when compared with the control groups at baseline. After alpha blockade, there was marked reduction in the mean LVEDD, LVEDV, LVESV, and normalization of E/A ratio (p < 0.001) in the PPGL patients. Following curative surgery (normalization of fractionated urinary metanephrines at 7–10 days post‐operatively), there was early improvement in all echocardiographic parameters and it continued to improve even at 6 months after surgery. There was marked improvement in the global longitudinal strain as seen on serial speckle tracking echocardiography with recovery of most of the segments of LV depicting the reversal of subclinical endocardial dysfunction (p < 0.001). Conclusion PPGL patients despite normal systolic function have subclinical LV diastolic dysfunction which is reversed after curative surgery. Trial Registration ClinicalTrials.gov NCT05082311.

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Subclinical left ventricular systolic dysfunction detected by two‐dimensional speckle tracking echocardiography in patients with pheochromocytoma and paraganglioma and preserved ejection fraction

Cited by 10 publications

References 16 publications

Hypertension and cardiac damage in pheochromocytoma and paraganglioma patients: a large-scale single-center cohort study

Hypertension and cardiac damage in pheochromocytoma and paraganglioma patients: a large-scale single-center cohort study

A Late-Detected Paraganglioma in a Young Patient with Resistant Hypertension and Severe Aortic Regurgitation—A Case Report and Review of the Literature

Cardiac Changes and Their Reversal Following Curative Surgery in Pheochromocytoma: PheoCard Prospective Cohort Study

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