Johnson Karen Kristina Nyvold, Stemann Lau Tobias, Mark Dahl Baunwall Simon, Elisabeth Villadsen Gerda, Guldbrand Rasmussen Vibeke, Grønbaek Henning, Oksjoki Riina Karoliina, Dam Gitte
Department of Hepatology and Gastroenterology, ENETS Center of Excellence, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
J Neuroendocrinol. 2023 Oct;35(10):e13327. doi: 10.1111/jne.13327. Epub 2023 Aug 13.
Carcinoid heart disease (CHD) is a serious complication for patients with neuroendocrine tumors (NETs), and early detection is crucial. We aimed to investigate N-terminal pro-brain natriuretic peptide (NT-proBNP), chromogranin A (CgA), and plasma 5-hydroxyindoleacetic acid (P-5-HIAA) as a screening tool for detection of CHD. We prospectively included patients with disseminated small intestinal NETs (SI-NETs) and performed transthoracic echocardiography (TTE), questionnaires, and biochemical assessment of NT-proBNP, CgA, and P-5-HIAA. The presence and severity of CHD was assessed using a scoring system based on echocardiographic characteristics. A total of 93 patients were included in the final analysis. Fifteen (16%) were diagnosed with CHD. The median NT-proBNP (219 ng/L vs. 124 ng/L, p = .05), CgA (3930 pmol/L vs. 256 pmoL/L, p < .0001), and P-5-HIAA (1160 nmol/L vs. 210 nmoL/L, p < .0001) were significantly higher in patients with CHD compared to non-CHD patients. For NT-proBNP, the area under the receiver operating characteristic (AUROC) curve for detection of CHD was 0.67 (95% CI: 0.50-0.84), and at a 260 ng/L cutoff level, the sensitivity and specificity were 46% and 79%. For CgA, the AUROC was 0.91 (95% CI: 0.84-0.97), and at a cutoff level of 598 pmol/L, the sensitivity and specificity were 100% and 69%. For P-5-HIAA, the AUROC was 0.89 (95% CI: 0.80-0.98), and at a cutoff level of 752 nmol/L, the sensitivity and specificity were 92% and 85%. In conclusion, CgA and P-5-HIAA proved excellent markers of CHD while NT-proBNP lacked the required diagnostic accuracy to be used as a screening tool.
类癌性心脏病（CHD）是神经内分泌肿瘤（NETs）患者的一种严重并发症，早期检测至关重要。我们旨在研究N末端脑钠肽前体（NT-proBNP）、嗜铬粒蛋白A（CgA）和血浆5-羟吲哚乙酸（P-5-HIAA）作为检测CHD的筛查工具。我们前瞻性纳入了播散性小肠NETs（SI-NETs）患者，并进行了经胸超声心动图（TTE）检查、问卷调查以及NT-proBNP、CgA和P-5-HIAA的生化评估。使用基于超声心动图特征的评分系统评估CHD的存在和严重程度。最终分析共纳入93例患者。15例（16%）被诊断为CHD。与非CHD患者相比，CHD患者的NT-proBNP中位数（219 ng/L对124 ng/L，p = 0.05）、CgA（3930 pmol/L对256 pmol/L，p < 0.0001）和P-5-HIAA（1160 nmol/L对210 nmol/L，p < 0.0001）显著更高。对于NT-proBNP，检测CHD的受试者操作特征（AUROC）曲线下面积为0.67（95%CI：0.50 - 0.84），在260 ng/L的截断水平时，敏感性和特异性分别为46%和79%。对于CgA，AUROC为0.91（95%CI：0.84 - 0.97），在598 pmol/L的截断水平时，敏感性和特异性分别为100%和69%。对于P-5-HIAA，AUROC为0.89（95%CI：0.80 - 0.98），在752 nmol/L的截断水平时，敏感性和特异性分别为92%和85%。总之，CgA和P-5-HIAA被证明是CHD的优秀标志物，而NT-proBNP缺乏作为筛查工具所需的诊断准确性。
