Background: Carcinoid tumors are rare neuroendocrine tumors. An important complication is carcinoid heart disease (CHD), which mainly involves right sided valvular and ventricular pathology. The ability of conventional echocardiography to assess the right ventricle (RV) is limited and may underestimate RV involvement in CHD. This study examined the potential diagnostic use of tissue Doppler imaging (TDI) and speckle-tracking 2D strain in patients with carcinoid tumor without known CHD.
Methods: Patients with histologically proven carcinoid tumor without clinical evidence of CHD were eligible for the study and compared to age-matched controls. Patients with significant right sided valvular disease, pulmonary hypertension or known pulmonary disease were excluded. All participants underwent standard echocardiography including TAPSE and RV fractional area change (RVFAC) as well as TDI of the tricuspid valve annulus and 2-D strain of the RV.
Results: 23 patients with carcinoid (mean age 64.0 ± 9.1 yrs 14M/9F) and 25 controls (53.0 ± 11.6; 17M/8F) were entered into the study. There were no significant differences between patients and controls in measurements of TAPSE (23.4 ± 4.5 vs 22.4 ± 3.7 mm), RVFAC (40 ± 0.1 vs 44 ± 0.1 %) or TV TDI s wave ( 12.7 ± 2.2 vs 13.2 ± 1.7 cm/s). However, peak longitudinal systolic strain was significantly lower in patients (-0.25 ± 0.05 vs -0.287 ± 0.04 %, p = 0.034).
Conclusion: Our study suggests that measuring RV 2D strain may detect carcinoid patients with RV involvement prior to the appearance of clinical symptoms or RV abnormalities on conventional echocardiography thereby potentially enabling earlier treatment.
