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    Serial surveillance of carcinoid heart disease: factors associated with echocardiographic progression and mortality.

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    Authors
    Dobson, R
    Burgess, M
    Valle, Juan W
    Pritchard, D
    Vora, J
    Wong, C
    Chadwick, C
    Keevi, B
    Adaway, J
    Hofmann, U
    Poston, G
    Cuthbertson, D
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    Affiliation
    1] Neuroendocrine Tumour Group, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK [2] Department of Obesity & Endocrinology, University of Liverpool, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK.
    Issue Date
    2014-09-11
    
    Metadata
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    Abstract
    Background:Carcinoid heart disease is a complication of metastatic neuroendocrine tumours (NETs). We sought to identify factors associated with echocardiographic progression of carcinoid heart disease and death in patients with metastatic NETs.Methods:Patients with advanced non-pancreatic NETs and documented liver metastases and/or carcinoid syndrome underwent prospective serial clinical, biochemical, echocardiographic and radiological assessment. Patients were categorised as carcinoid heart disease progressors, non-progressors or deceased. Multinomial regression was used to assess the univariate association between variables and carcinoid heart disease progression.Results:One hundred and thirty-seven patients were included. Thirteen patients (9%) were progressors, 95 (69%) non-progressors and 29 (21%) patients deceased. Baseline median levels of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and plasma 5-hydroxyindoleacetic acid (5-HIAA) were significantly higher in the progressors. Every 100 nmol l(-1) increase in 5-HIAA yielded a 5% greater odds of disease progression (OR 1.05, 95% CI: 1.01, 1.09; P=0.012) and a 7% greater odds of death (OR 1.07, 95% CI: 1.03, 1.10; P=0.001). A 100 ng l(-1) increase in NT-proBNP did not increase the risk of progression, but did increase the risk of death by 11%.Conclusions:The biochemical burden of disease, in particular baseline plasma 5-HIAA concentration, is independently associated with carcinoid heart disease progression and death. Clinical and radiological factors are less useful prognostic indicators of carcinoid heart disease progression and/or death.British Journal of Cancer advance online publication, 11 September 2014; doi:10.1038/bjc.2014.468 www.bjcancer.com.
    Citation
    Serial surveillance of carcinoid heart disease: factors associated with echocardiographic progression and mortality. 2014: Br J Cancer
    Journal
    British Journal of Cancer
    URI
    http://hdl.handle.net/10541/332319
    DOI
    10.1038/bjc.2014.468
    PubMed ID
    25211656
    Type
    Article
    Language
    en
    ISSN
    1532-1827
    ae974a485f413a2113503eed53cd6c53
    10.1038/bjc.2014.468
    Scopus Count
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