Smith Sakima A, Waggoner Alan D, de las Fuentes Lisa, Davila-Roman Victor G
Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri 63110, USA.
J Am Soc Echocardiogr. 2009 Aug;22(8):883-9. doi: 10.1016/j.echo.2009.05.002. Epub 2009 Jun 23.
Serotonin plays a significant role in the development of carcinoid heart disease, which primarily leads to fibrosis and contraction of right-sided heart valves. Recently, strong evidence has emerged that the use of specific drug classes, such as ergot alkaloids (for migraine headaches), 5-hydroxytryptamine (5-HT or serotonin) uptake regulators or inhibitors (for weight reduction), and ergot-derived dopamine agonists (for Parkinson's disease), can result in left-sided heart valve damage that resembles carcinoid heart disease. Recent studies have suggested that both right-sided and left-sided drug-induced heart valve disease involves increased serotoninergic activity and in particular activation of the 5-HT receptors, including the 5-HT2B receptor subtype, which mediate many of the central and peripheral functions of serotonin. G-proteins that inhibit adenylate cyclase activity mediate the activity of the 5-HT2B receptor subunit, which is widely expressed in a variety of tissues, including liver, lung, heart, and coronary and pulmonary arteries; it has also been reported in embryonic mouse heart, particularly on mouse heart valve leaflets. In this review, the authors discuss the salient features of serotoninergic manifestations of both carcinoid heart disease and drug-induced cardiac valvulopathy, with an emphasis on echocardiographic diagnosis.
血清素在类癌性心脏病的发展中起重要作用，类癌性心脏病主要导致右侧心脏瓣膜纤维化和挛缩。最近，有确凿证据表明，使用特定药物类别，如麦角生物碱（用于偏头痛）、5-羟色胺（5-HT或血清素）摄取调节剂或抑制剂（用于减肥）以及麦角衍生的多巴胺激动剂（用于帕金森病），可导致类似于类癌性心脏病的左侧心脏瓣膜损伤。最近的研究表明，右侧和左侧药物性心脏瓣膜病均涉及血清素能活性增加，特别是5-HT受体的激活，包括5-HT2B受体亚型，这些受体介导血清素的许多中枢和外周功能。抑制腺苷酸环化酶活性的G蛋白介导5-HT2B受体亚基的活性，该亚基在包括肝脏、肺、心脏以及冠状动脉和肺动脉在内的多种组织中广泛表达；在胚胎小鼠心脏中也有报道，特别是在小鼠心脏瓣膜小叶上。在这篇综述中，作者讨论了类癌性心脏病和药物性心脏瓣膜病血清素能表现的显著特征，重点是超声心动图诊断。
