Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria.
Department of Internal Medicine, Oberndorf Hospital, Salzburg, Austria.
ESC Heart Fail. 2019 Feb;6(1):222-227. doi: 10.1002/ehf2.12396. Epub 2019 Jan 8.
Herein, we report the case of a 67-year-old woman who was admitted to our hospital because of dyspnoea and oedema of the lower extremities. Transthoracic echocardiography revealed severe tricuspid and mitral regurgitation, and the leaflets of the tricuspid valve were found to be rigid and almost immobile. The plasma concentrations of serotonin and chromogranin A were elevated, and hence, suspicion for carcinoid heart disease was raised. In addition to the diagnostic workup and medical and surgical treatment, we analysed levels of novel cardiovascular biomarkers throughout the entire follow-up by means of enzyme-linked immunosorbent assay. A dopa positron emission tomography (DOPA-PET) was conducted and showed a neoplasm in the terminal ileum. Tricuspid valve replacement, mitral valve repair, and a closure of the patent foramen ovale (PFO) were conducted. Two months later, hemicolectomy and liver segment resection were performed. The tumour was resected, and the diagnosis of a neuroendocrine tumour (NET) was confirmed. Throughout the follow-up, we observed a decrease in the plasma levels of novel biomarkers [e.g. interleukin-8 (IL-8), soluble suppression of tumorigenicity-2 (sST2), and heart-type fatty acid-binding protein (H-FABP)] over the follow-up period. In our case, carcinoid heart disease resulted in a severe tricuspid regurgitation as commonly seen in these patients. Moreover, a pre-existent mitral regurgitation was likely aggravated by fibrotic remodelling, because a PFO has led to a right-to-left shunt and might have caused left heart involvement. As IL-8 was associated with adverse outcomes in patients with NETs, and sST2 and H-FABP were associated with adverse outcomes in patients with heart failure previously, these biomarkers could aid in the risk stratification of patients with NET.
在此，我们报告了一例 67 岁女性因呼吸困难和下肢水肿而入院的病例。经胸超声心动图显示严重的三尖瓣和二尖瓣反流，三尖瓣瓣叶僵硬且几乎不动。血浆中 5-羟色胺和嗜铬粒蛋白 A 的浓度升高，因此怀疑为类癌性心脏病。除了诊断性检查和内科及外科治疗外，我们还通过酶联免疫吸附试验在整个随访过程中分析了新型心血管生物标志物的水平。进行了多巴胺正电子发射断层扫描（DOPA-PET），显示回肠末端有一个肿瘤。进行了三尖瓣置换、二尖瓣修复和卵圆孔未闭（PFO）闭合。两个月后，进行了横结肠切除术和肝段切除术。肿瘤被切除，确诊为神经内分泌肿瘤（NET）。在整个随访期间，我们观察到新型生物标志物[如白细胞介素-8（IL-8）、可溶性抑制肿瘤生成 2（sST2）和心脏型脂肪酸结合蛋白（H-FABP）]的血浆水平在随访期间下降。在我们的病例中，类癌性心脏病导致了严重的三尖瓣反流，这在这些患者中很常见。此外，先前存在的二尖瓣反流可能因纤维化重塑而加重，因为 PFO 导致右向左分流，并可能导致左心受累。由于 IL-8 与 NET 患者的不良预后相关，sST2 和 H-FABP 与心力衰竭患者的不良预后相关，因此这些生物标志物可能有助于 NET 患者的风险分层。
