Cardiac manifestations in mid-gut carcinoid disease

Eur Heart J. 1995 Feb;16(2):263-8. doi: 10.1093/oxfordjournals.eurheartj.a060894.


The extent of heart disease and its relationship to the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), was studied with M-mode, 2D and Doppler echocardiography in 42 consecutive patients, 30 females and 12 males, median age 63 (range 23-75) years with histologically verified mid-gut tumour, liver metastases and 24-h urinary 5-HIAA excretion above 47 mumol.24 h-1. All patients had normal left ventricular ejection fractions, median 65% (interquartile range (IQR) 54-74%). Moderate to severe tricuspid regurgitation (TR) was diagnosed in 22 patients (59%); mitral or aortic regurgitation was found in nine (24%) and six (16%) patients, respectively. The mitral flow peak early (E) on late (A) velocity ratio was significantly decreased compared to age-matched normal subjects. The group of patients with 5-HIAA excretion exceeding 1000 mumol.24h-1 contained significantly more patients with severe TR than those with a lower excretion. The decrease in the E/A ratio may indicate reduced left ventricular compliance, possibly secondary to fibrous changes similar to those seen intra-abdominally and in the right side of the heart. As serotonin is degraded in the lung circulation, other mediators such as tachykinins and cytokines (PDGF) may be involved.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Flow Velocity
  • Carcinoid Tumor / complications
  • Carcinoid Tumor / diagnostic imaging
  • Carcinoid Tumor / urine*
  • Female
  • Heart Diseases / diagnostic imaging
  • Heart Diseases / etiology*
  • Heart Diseases / physiopathology
  • Humans
  • Hydroxyindoleacetic Acid / urine*
  • Intestinal Neoplasms / complications
  • Intestinal Neoplasms / diagnostic imaging
  • Intestinal Neoplasms / pathology
  • Intestinal Neoplasms / urine*
  • Male
  • Middle Aged
  • Prognosis
  • Radiography
  • Retrospective Studies
  • Ultrasonography
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology


  • Hydroxyindoleacetic Acid