Evaluation of Right Ventricular Dysfunction by Myocardial Strain Echocardiography in Patients With Intestinal Carcinoid Disease

J Am Soc Echocardiogr. 2011 Jun;24(6):644-50. doi: 10.1016/j.echo.2011.02.009. Epub 2011 Mar 25.

Abstract

Background: Cardiac fibrosis is an important complication of intestinal carcinoid disease, with resulting valvular and ventricular dysfunction due to endocardial fibrosis. Evaluation of right ventricular (RV) function in these patients has focused on valvular involvement. The aim of this study was to investigate whether myocardial strain by echocardiography can detect RV dysfunction in patients with carcinoid disease.

Methods: Eighty-nine patients with intestinal carcinoid and 50 healthy individuals were studied. Strain measurements were assessed by speckle-tracking echocardiography. The average of the three lateral RV segments was calculated as RV strain. Left ventricular global strain was calculated from a 16-segment model.

Results: Carcinoid heart disease was present in 15 of the 89 patients. RV strain was reduced in patients with carcinoid disease compared with healthy controls (-20.6 ± 5.0% vs -26.9 ± 4.4%, P < .001). RV function by strain was not significantly different in patients with and without carcinoid heart disease (-21.2 ± 5.7% vs -20.5 ± 4.8%, P = .59). Excluding patients with overt carcinoid heart disease, RV strain was reduced in patients with 5-hydroxyindoleacetic acid levels above the normal range compared with those with levels within the normal range (-19.4 ± 5.4 vs -21.6 ± 3.7%, P = .05).

Conclusions: RV function by myocardial strain was reduced in patients with carcinoid disease independently of valvular involvement. This indicates that myocardial strain by echocardiography provides added information about RV function in patients with intestinal carcinoid disease.

MeSH terms

  • Analysis of Variance
  • Carcinoid Tumor / complications*
  • Chi-Square Distribution
  • Echocardiography / methods*
  • Female
  • Heart Rate
  • Humans
  • Intestinal Neoplasms / complications*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Statistics, Nonparametric
  • Ventricular Dysfunction, Right / diagnostic imaging*
  • Ventricular Dysfunction, Right / etiology*
  • Ventricular Dysfunction, Right / physiopathology