CARCINOID HEART-DISEASE - CLINICAL AND ECHOCARDIOGRAPHIC SPECTRUM IN 74 PATIENTS
CARCINOID HEART-DISEASE - CLINICAL AND ECHOCARDIOGRAPHIC SPECTRUM IN 74 PATIENTS
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DOI：
10.1161/01.cir.87.4.1188
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发表时间：
1993-04-01
期刊：
影响因子：
37.8
通讯作者：
KVOLS, LK
中科院分区：
文献类型：
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作者：
PELLIKKA, PA;TAJIK, AJ;KVOLS, LK
背景。类癌综合征是一种罕见的原因获得性瓣膜性心脏病。虽然类癌性心脏病的典型超声心动图特征已经得到了很好的认识，但这一系列的研究为这种疾病的异常表现以及多普勒超声心动图的作用提供了新的信息。方法与结果。1980年至1989年间，132例类癌综合征患者接受了超声心动图研究。本文描述了74例（56%）具有类癌性心脏病超声心动图证据的患者的超声心动图、多普勒和临床特征。在这些患者中，97%的三尖瓣小叶缩短、增厚。所有69例接受多普勒检查的类癌性心脏病患者均存在三尖瓣反流，62例（90%）为中度或重度。严重三尖瓣反流的多普勒频谱特征为尖刀形，血压峰值早，下降快。压力半衰期延长（平均116毫秒），这与相关的三尖瓣狭窄一致。36例（49%）患者出现肺动脉瓣增厚、缩回和不动，另外29例（39%）患者出现肺动脉瓣小到无法观察到的程度。在47例接受多普勒肺动脉瓣评估的患者中，81%的患者出现反流，53%的患者出现狭窄。左侧瓣膜受累5例（7%），其中4例有卵圆孔未闭或类癌累及肺。先前未描述的心肌转移存在于3例患者（4%）中，并且每个病例都通过活检证实。10例（14%）患者有少量心包积液。有和没有超声心动图证据的类癌性心脏病患者在性别、年龄、原发肿瘤位置、诊断时间或类癌综合征症状持续时间方面没有差异。然而，尿中5-羟基吲哚乙酸的平均预处理水平在类癌性心脏病患者中高于非类癌性心脏病患者(270 mg/24小时vs 131 mg/24小时，p
Background. The carcinoid syndrome is a rare cause of acquired valvular heart disease. Although the typical echocardiographic features of carcinoid heart disease are well recognized, this large series provides new information about unusual manifestations of the disease as well as the role of Doppler echocardiography.Methods and Results. Between 1980 and 1989, 132 patients with carcinoid syndrome underwent echocardiographic study. The echocardiographic, Doppler, and clinical features of the 74 patients (56%) with echocardiographic evidence of carcinoid heart disease are described. Among these patients, 97% had shortened, thickened tricuspid leaflets. Tricuspid regurgitation was present in all 69 patients with carcinoid heart disease who underwent Doppler examination, and it was of moderate or severe degree in 62 patients (90%). Severe tricuspid regurgitation was characterized by a dagger-shaped Doppler spectral profile with an early peak pressure and rapid decline. The pressure half-time was prolonged (mean, 116 msec), which is consistent with associated tricuspid stenosis. The pulmonary valve appeared thickened, retracted, and immobile in 36 patients (49%) and was diminutive to the extent of not being visualized in an additional 29 patients (39%). Among the 47 patients who underwent Doppler evaluation of the pulmonary valve, regurgitation was present in 81%, and stenosis was present in 53%. Left-sided valvular involvement was present in five patients (7%), four of whom had patent foramen ovale or carcinoid tumor involving the lung. Previously undescribed myocardial metastases were present in three patients (4%) and were confirmed by biopsy in each case. Small pericardial effusions were present in 10 patients (14%). Patients with and without echocardiographic evidence of carcinoid heart disease did not differ with regard to sex, age, location of the primary tumor, duration of diagnosis, or duration of symptoms of carcinoid syndrome. However, the mean pretreatment level of urinary 5-hydroxyindoleacetic acid was higher in patients with carcinoid heart disease than in patients without carcinoid heart disease (270 versus 131 mg/24 hrs, p