SFEBES2014 Poster Presentations Obesity, diabetes, metabolism and cardiovascular (80 abstracts)
High incidence of cardiac involvement in patients diagnosed with phaeochromocytoma: a clinical study using cardiovascular magnetic resonance imaging
Vanessa Ferreira 1 , Mafalda Rodrigues 2 , Stefan Piechnik 1 , Claudia Marini 1 , Theodoros Karamitsos 1 , Jane Francis 1 , Ranjit Arnold 1 , Radu Mihai 3 , Julia Thomas 4 , Maria Herincs 4 , Marta Korbonits 4 , Zaki Hassan-Smith 5 , Wiebke Arlt 5 , Niki Karavitaki 2 , Ashley Grossman 2 , Stefan Neubauer 1 & John Wass 2
1Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK; 2Department of Endocrinology, Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, University of Oxford, Oxford, UK; 3Department of Surgery, Oxford University Hospitals NHS Trust (OUH), John Radcliffe Hospital, Oxford, UK; 4Department of Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, UK; 5School of Clinical and Experimental Medicine, Centre for Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Birmingham, UK.
Background: In patients with phaeochromocytoma, sudden and/or chronic exposure to catecholamines may predispose to cardiac pathology, including left ventricular (LV) hypertrophy, myocardial infarction, stress-induced cardiomyopathy and heart failure. We conducted the first prospective, multicentre study using cardiovascular magnetic resonance (CMR) imaging to describe the variety and incidence of cardiac abnormalities in phaeochromocytoma.
Methods: Fifty patients diagnosed with phaeochromocytoma were included. We prospectively recruited patients newly-diagnosed with phaeochromocytoma (n=20) with CMR before and after surgery (median 1 year follow-up). Previously-diagnosed patients who had curative surgery (n=30) were also recruited. Patients with known cardiac conditions were excluded. CMR included cine imaging for LV function, T2-weighted imaging for oedema and late gadolinium enhancement imaging to detect scarring.
Results: In newly-diagnosed patients, the mean LV ejection fraction was 67±10% (range 47–88%; normal 57–81%); 20% (n=4/20) had mild global LV dysfunction (EF=47–56%). A significant proportion (65%, n=13/20) demonstrated scarring, all with a non-ischaemic pattern (midwall/subepicardial/patchy), but the areas were small (<10% myocardium); no patient had myocardial infarction (subendocardial scarring). One patient demonstrated global myocardial oedema with normal EF. All LV dysfunction or oedema normalised in postoperative follow-up. Previously-diagnosed patients had a slightly higher EF of 73±7% (56–86%) compared to newly-diagnosed patients (P<0.03); only one (3%) had mild global LV dysfunction (EF=56%). A significantly smaller proportion of previously-diagnosed patients (17%, n=5/30; P<0.001) demonstrated areas of scarring, which again were small with a non-ischaemic pattern, except for one patient who suffered a small myocardial infarction.
Conclusion: Cardiac involvement is common (65%) in patients newly-diagnosed with phaeochromocytoma, including small areas of non-ischaemic scarring, mild LV dysfunction and myocardial oedema – the latter two demonstrating full reversibility and normalization post surgical resection of the phaeochromocytoma. In patients previously undergone curative surgical resection, the incidence of cardiac abnormalities is lower (17%), predominantly consisting of small areas of non-ischaemic fibrosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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