Improving outcomes in carcinoid heart disease - learning from a single centre

Area of Science:

• Cardiology
• Oncology
• Nuclear Medicine

Background:

• Carcinoid heart disease (CHD) significantly impacts patients with carcinoid syndrome, often leading to right heart failure and poor prognosis due to valve degeneration.
• Valve replacement surgery is an effective treatment for CHD, improving patient outcomes.
• This study investigates prognostic factors in patients with CHD undergoing valve replacement.

Approach:

• A retrospective review of 26 patients with CHD who underwent valve replacement between 2003 and 2019.
• Analysis of patient demographics, tumor grade, New York Heart Association (NYHA) functional class, valves replaced, and treatment with Lu177 oxodotreotide.
• Survival analysis using Cox proportional hazards model to identify prognostic factors.

Key Points:

• Patients undergoing valve replacement were typically NYHA class II, with significant symptom improvement post-surgery (mean NYHA decrease of 0.71, P=0.002).
• 88.5% of patients required replacement of two valves (tricuspid and pulmonary regurgitation).
• Survival analysis indicated that completing four cycles of Lu177 oxodotreotide was associated with improved survival (HR 0.087, P=0.045), despite a wide confidence interval.

Conclusions:

• Valve replacement surgery effectively improves symptoms in patients with carcinoid heart disease.
• Four cycles of Lu177 oxodotreotide show potential for improving survival in CHD patients.
• Further research is warranted to confirm the role of Lu177 oxodotreotide in managing carcinoid heart disease.