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Clinical Trial
. 2004 Jun 1;90(11):2073-9.
doi: 10.1038/sj.bjc.6601816.

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

J M Zuetenhorst  1 , C M Korse, J M G Bonfrer, R H Bakker, B G Taal
Affiliations
Clinical Trial

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

J M Zuetenhorst et al. Br J Cancer. .

Abstract

Carcinoid heart disease (CHD) occurs in 20-70% of the patients with metastatic well-differentiated neuroendocrine tumours (NET). We evaluated whether natriuretic peptides (ANP or NT-proBNP) are useful in early detection of CHD. Blood samples from 32 patients with NET were compared with cardiac ultrasound follow-up. CHD was defined as thickening of the tricuspid valve in the presence of grade III-IV/IV tricuspid valve regurgitation. CHD was found in nine out of 32 patients (28%), all with symptoms of the carcinoid syndrome compared to 65% in the 23 patients without CHD (P=0.04). Median levels of NT-proBNP and 5-HIAA were significantly higher in patients with CHD (894 ng l(-1) and 815 micromol 24 h(-1)) compared to those without (89 and 206 ng l(-1), P<0.001 and P=0.007). No significant differences were detected in ANP levels (P=0.11). Dilatation of the right atrium and ventricle as well as thickening of the tricuspid valve and degree of regurgitation were statistically significant correlated with NT-proBNP levels. The accuracy of NT-proBNP in the diagnosis of CHD was higher than that of ANP. A significantly better survival was observed in case of normal NT-proBNP values. In conclusion, NT-proBNP is helpful as a simple marker in the diagnosis of CHD. Survival is better in patients with normal levels of NT-proBNP.

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Figures

Figure 1
Figure 1
The median NT-proBNP serum level is significantly higher in patients with CHD compared to those without. The difference in ANP levels is not significant. Boxes are median and interquartiles range, whiskers show ranges excluding outliers. Values beyond the lines are considered outliers (+).
Figure 2
Figure 2
The median NT-proBNP serum level is significantly correlated with the degree of dilatation of the right ventricle. Boxes are median and interquartiles range, whiskers show ranges. Values beyond the lines are considered outliers (+).
Figure 3
Figure 3
The ROC curve shows that the accuracy to differentiate between patients with and without heart disease is the best in NT-proBNP compared to ANP levels.
Figure 4
Figure 4
Kaplan–Meier curves show a significant better survival in patients with normal levels of NT-proBNP compared to those with elevated levels. This does not apply for the levels of ANP.
See this image and copyright information in PMC

References

    1. Bay M, Kirk V, Parner J, Hassager C, Nielsen H, Krogsgaard K, Trawinski J, Boesgaard S, Aldershvile J (2003) NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart 89: 150–154 - PMC - PubMed
    1. Capella C, Heitz PU, Hofler H, Solcia E, Kloppel G (1995) Revised classification of neuroendocrine tumours of the lung, pancreas and gut. Virchows Arch 425: 547–560 - PubMed
    1. Clerico A, Del Ry S, Maffei S, Prontera C, Emdin M, Giannessi D (2002) The circulating levels of cardiac natriuretic hormones in healthy adults: effects of age and sex. Clin Chem Lab Med 40: 371–377 - PubMed
    1. Cowie MR, Struthers AD, Wood DA, Coats AJ, Thompson SG, Poole-Wilson PA, Sutton GC (1997) Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet 350: 1349–1353 - PubMed
    1. Davidson NC, Naas AA, Hanson JK, Kennedy NS, Coutie WJ, Struthers AD (1996) Comparison of atrial natriuretic peptide B-type natriuretic peptide, and N-terminal proatrial natriuretic peptide as indicators of left ventricular systolic dysfunction. Am J Cardiol 77: 828–831 - PubMed