Screening for carcinoid heart disease: Trends and future Perspectives

Area of Science:

• Cardiology
• Oncology
• Medical Guidelines

Background:

• Carcinoid heart disease (CHD) screening lacked expert guidelines historically.
• The North American Neuroendocrine Tumor Society (NANETS) released recommendations in 2017 for CHD screening in neuroendocrine tumor (NET) patients.
• This study evaluates CHD screening trends and guideline utility over two decades at a tertiary care center.

Purpose of the Study:

• To assess the impact of NANETS expert recommendations on CHD screening practices.
• To evaluate the trends in CHD screening over more than 20 years.
• To determine the utility of specific screening criteria for CHD in NET patients.

Main Methods:

• Retrospective review of 334 patients with NETs undergoing surgical evaluation.
• Data collected from 1999-2018 and 2021-2022.
• Recorded lab values and clinical features against NANETS criteria: liver metastasis, serotonin levels, NT-ProBNP, and clinical CHD signs.

Main Results:

• 85% of patients met at least one NANETS screening criterion.
• Only 40% of eligible patients received echocardiogram screening.
• Screening rates increased from 32% to 40.6% between the first and second decades, rising to 70% post-guideline publication.
• Patients with multiple criteria were more likely to have structural valve disease.

Conclusions:

• Implementation of NANETS-recommended screening criteria significantly increased echocardiogram utilization for CHD screening.
• These criteria can aid in the early detection of CHD in NET patients.
• Patients meeting multiple screening criteria showed a higher likelihood of structural valve disease, highlighting the importance of comprehensive screening.