(Circulation. 1995;92:790-795.)
© 1995 American Heart Association, Inc.
Articles |
Carcinoid Heart Disease
Correlation of High Serotonin Levels With Valvular Abnormalities Detected by Cardiac Catheterization and Echocardiography
From the Divisions of Cardiology, Duke University Medical Center, Durham, NC, and the Division of Internal Medicine, Durham (NC) VA Medical Center.
Correspondence to Thomas M. Bashore, MD, Duke University Medical Center, PO Box 3012, Durham, NC 27710.
Background Although serotonin has been postulated as an etiologic agent in the development of carcinoid heart disease, no direct evidence for different ambient serotonin levels in cardiac and noncardiac patients has been reported to date.
Methods and Results The present study reviews our experience with 604 patients in the Duke Carcinoid Database. Nineteen patients with proven carcinoid heart disease (by cardiac catheterization and/or echocardiogram) were compared with the remaining 585 noncardiac patients in the database with regard to circulating serotonin and its principal metabolite, 5-hydroxyindole acetic acid (5-HIAA). No significant demographic differences existed between the cardiac and noncardiac groups; however, typical carcinoid syndrome symptoms (ie, flushing and diarrhea) were almost threefold more common in the cardiac group (P<.001). Compared with the noncardiac group, heart disease patients demonstrated strikingly higher (P<.0001) mean serum serotonin (9750 versus 4350 pmol/mL), plasma serotonin (1130 versus 426 pmol/mL), platelet serotonin (6240 versus 2700 pmol/mg protein), and urine 5-HIAA (219 versus 55.3 mg/24 h) levels. The spectrum of heart disease among the 19 patients showed a strong right-sided valvular predominance, with tricuspid regurgitation being the most common valvular dysfunction (92% by cardiac catheterization; 100% by echocardiogram).
Conclusions These data suggest that serotonin plays a major role in the pathogenesis of the cardiac plaque formation observed in carcinoid patients.
Key Words: serotonin • heart diseases • valves
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