Highlights
- •Carcinoid heart disease (CHD) incidence was 14% of patients with metastases and 25% of patients with carcinoid syndrome.
- •CHD patients with valve replacement operations had a 0% operative mortality and yielded longer-term survival rates.
- •Hepatic cytoreduction may reduce the risk of subsequent CHD.
- •Our data do not support a protective effect of octreotide to prevent new or recurrent CHD.
Abstract
Background
Carcinoid heart disease (CHD) is a sequela of carcinoid liver metastases (LM). The
true prevalence of CHD is unknown due to infrequent screening by transthoracic echocardiography
(TTE). Octreotide is believed to protect against new and recurrent CHD, but supporting
data are scant. This study determined CHD prevalence and outcomes in patients screened
by TTE and treated with octreotide.
Methods
Records of carcinoid patients from 2001 to 2021 were reviewed. Survival was estimated
by Kaplan-Meyer curves and compared by log-rank.
Results
Among 282 patients screened by TTE, overall survival was lower in CHD (n = 40) versus
non-CHD (n = 242) patients (p < 0.001). Despite octreotide therapy, 21 patients developed
CHD. Among patients with inoperable LM, survival was lower in CHD patients without
valve replacement (VR) (p < 0.001), but similar between CHD patients with VR and non-CHD
patients. CHD patients with VR and hepatic cytoreduction had survival similar to CHD
patients without VR.
Conclusion
VR improves survival in CHD patients with inoperable LM. Hepatic cytoreduction after
VR should be reserved for carefully selected cases. Our data do not support a protective
effect of octreotide.
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Article info
Publication history
Published online: March 30, 2022
Accepted:
March 28,
2022
Received in revised form:
February 8,
2022
Received:
November 15,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
