Department of Endocrinology, Medical Faculty, Medical University Sofia, Sofia, Bulgaria.
Expert Center for Rare Endocrine Diseases, Sofia, Bulgaria.
Endocr Relat Cancer. 2020 Oct;27(10):561-570. doi: 10.1530/ERC-20-0137.
Cardiomyopathy is a frequent complication of pheochromocytoma, and echocardiography is the most accessible method for its evaluation. The objective of this study was to assess the clinical significance of classical and novel echocardiographic parameters of cardiac function in 24 patients with pheochromocytomas (PPGL) compared to 24 subjects with essential hypertension (EH). Fourteen PPGL patients were reassessed after successful surgery. Left ventricular hypertrophy was four times more prevalent in patients with PPGL vs EH (75% vs 17%; P = 0.00005). Left ventricular mass index (LVMi) significantly correlated with urine metanephrine (MN) (rs = 0.452, P = 0.00127) and normetanephrine (NMN) (rs = 0.484, P = 0.00049). Ejection fraction (EF) and endocardial fractional shortening (EFS) were normal in all participants and did not correlate with urine metanephrines. Global longitudinal strain (GLS) was significantly lower in PPGL compared to EH group (-16.54 ± 1.83 vs -19.43 ± 2.19; P < 0.00001) and revealed a moderate significant positive correlations with age (rs = 0.489; P = 0.015), LVMi (rs = 0.576, P < 0.0001), MN (rs = 0.502, P = 0.00028) and NMN (rs = 0.580, P < 0.0001). Relative wall thickness (RWT) showed a strong positive correlation with urine MN (rs = 0.559, P < 0.0001) and NMN (rs = 0.689, P < 0.00001). Markedly decreased LVMi (118.2 ± 26.9 vs 102.9 ± 22.3; P = 0.007) and significant improvement in GLS (-16.64 ± 1.49 vs -19.57 ± 1.28; P < 0.001) was observed after surgery. ΔGLS depended significantly on the follow-up duration. In conclusion, classical echocardiographic parameters usually used for assessment of systolic cardiac function are not reliable tests in pheochromocytoma patients. Instead, GLS seems to be a better predictor for the severity and the reversibility of catecholamine-induced myocardial function damage in these subjects. RWT should be measured routinely as an early indicator of cardiac remodeling.
肥厚型心肌病是嗜铬细胞瘤的常见并发症，超声心动图是评估其的最便捷方法。本研究旨在比较 24 例嗜铬细胞瘤（PPGL）患者和 24 例原发性高血压（EH）患者的经典和新型超声心动图心功能参数的临床意义。14 例 PPGL 患者在成功手术后进行了重新评估。与 EH 患者相比，PPGL 患者的左心室肥厚患病率高出四倍（75%比 17%；P=0.00005）。左心室质量指数（LVMi）与尿间甲肾上腺素（MN）（rs=0.452，P=0.00127）和去甲变肾上腺素（NMN）（rs=0.484，P=0.00049）显著相关。所有参与者的射血分数（EF）和心内膜短轴缩短率（EFS）均正常，与尿间甲肾上腺素无相关性。与 EH 组相比，PPGL 患者的整体纵向应变（GLS）明显降低（-16.54±1.83 比-19.43±2.19；P<0.00001），且与年龄（rs=0.489；P=0.015）、LVMi（rs=0.576，P<0.0001）、MN（rs=0.502，P=0.00028）和 NMN（rs=0.580，P<0.0001）呈中度显著正相关。相对室壁厚度（RWT）与尿 MN（rs=0.559，P<0.0001）和 NMN（rs=0.689，P<0.00001）呈强正相关。手术后，LVMi 显著降低（118.2±26.9 比 102.9±22.3；P=0.007），GLS 明显改善（-16.64±1.49 比-19.57±1.28；P<0.001）。GLS 的变化取决于随访时间。总之，经典超声心动图参数通常用于评估收缩期心功能，但在嗜铬细胞瘤患者中并不是可靠的检查方法。相反，GLS 似乎是这些患者中儿茶酚胺诱导心肌功能损伤严重程度和可逆性的更好预测因子。RWT 应作为心脏重构的早期指标进行常规测量。
