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.
|Publication status||Published - 2014|
|Event||Society for Endocrinology (BES 2014) - Liverpool, United Kingdom|
Duration: 24 Mar 2014 → 27 Mar 2014
|Conference||Society for Endocrinology (BES 2014)|
|Period||24/03/14 → 27/03/14|