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Published on: August 28, 2018
Features of carcinoid heart disease identified by cardiac computed tomography
Joseph Davar1, Olga Lazoura2, Martyn E Caplin3
1Carcinoid Heart Disease Clinic, Department of Cardiology, Royal Free Hospital, London, United Kingdom.
Insights
Cardiac computed tomography (CT) effectively assesses carcinoid heart disease (HD) valve damage, including coronary arteries and myocardial metastasis. This imaging modality is crucial for multimodal assessment of this complex condition.
Area of Science:
- Cardiology
- Radiology
- Oncology
Background:
- Carcinoid heart disease (HD) is a rare valvular heart disease with incompletely described features on cardiac computed tomography (CT).
- Limited understanding of cardiac CT's role in evaluating carcinoid HD necessitates further investigation.
Purpose of the Study:
- To evaluate the utility of cardiac CT in assessing valvular abnormalities in patients with carcinoid heart disease.
- To describe the spectrum of cardiac involvement in carcinoid HD using cardiac CT.
- To assess the relationship between coronary arteries and myocardial metastasis in carcinoid HD patients via cardiac CT.
Main Methods:
- Retrospective review of 32 patients with carcinoid HD who underwent cardiac CT between April 2006 and December 2019.
- Analysis of cardiac CT scans for valvular involvement, myocardial metastases, and pericardial disease.
- Correlative analysis with surgical findings and echocardiography where available.
Main Results:
- 91% of patients (29/32) showed heart valve involvement, predominantly tricuspid and pulmonary valves.
- Severe regurgitation was common in affected valves (≥75% for tricuspid, pulmonary, aortic).
- Cardiac CT accurately assessed leaflet damage, especially for the pulmonary valve, where echocardiography was often incomplete.
Conclusions:
- Cardiac CT is a powerful tool for assessing valvular abnormalities in carcinoid HD.
- It aids in evaluating coronary arteries and myocardial metastasis, guiding multimodal imaging strategies.
- Cardiac CT should be integral to the imaging workup of carcinoid heart disease.
Background:
Carcinoid heart disease (HD) is a rare form of valvular heart disease, the features of which have not been fully described by cardiac computed tomography (CT).
Methods:
All patients with carcinoid HD that underwent cardiac CT, either preoperatively or for assessment of coronary arteries, between Apr-2006 and Dec-2019 at the Royal Free Hospital, UK, were reviewed.
Results:
Of 32 patients with carcinoid HD, 29 (91%) had heart valve involvement. Abnormalities of the tricuspid and pulmonary valves were present in all patients, affecting all three leaflets in 23/26 (89%) unoperated patients for both valves. The aortic valve was affected in 4/29 (14%) patients and the mitral valve in 5/29 (17%). Left heart valves were affected in 6/29 (21%) patients. One patient (1/29; 3%) had all four valves affected. Severe changes with significant valvular regurgitation were seen in ≥75% of patients with tricuspid, pulmonary, and aortic valve abnormalities. Three patients had carcinoid myocardial metastases (3/32; 9%) and one patient had constrictive pericarditis (1/32; 3%). Ten patients had surgery of whom four (40%) had invasive coronary angiography preoperatively. Ten patients had a patent foramen ovale. Cardiac CT allowed an accurate assessment of damage to different leaflets/cusps, particularly of the pulmonary valve, where visualization with echocardiography was often (3/8; 38%) incomplete.
Conclusion:
Cardiac CT is a powerful tool for assessment of cardiac valve abnormalities, coronary arteries and the spatial relationship of coronary arteries with myocardial metastasis in patients with carcinoid HD, and should form part of multimodal imaging of this complex pathology.
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