Cardiovascular dysfunction and catecholamine cardiomyopathy in pheochromocytoma patients and their reversal following surgical cure: Results of a prospective case-control study

• Published in: Surgery Vol. 150; no. 6; pp. 1202 - 1211
• Main Authors: Agarwal, Gaurav, MS, DNB, PDC (EndocrSurg), FACS, Sadacharan, Dhalapathy, MS, MCh (EndocrSurg), Kapoor, Aditya, MD, DM (Cardiol), Batra, Aditya, MD, Dabadghao, Preeti, MD, DM (Endocrinol), Chand, Gyan, MS, Mishra, Anjali, MS, PDC (EndocrSurg), Agarwal, Amit, MS, Verma, Ashok K., MS, FACS, Mishra, Saroj K., MS, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2011; Elsevier
• Subjects: Adolescent; Adrenal Gland Neoplasms - complications; Adrenal Gland Neoplasms - surgery; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathies - blood; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - etiology; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - etiology; Case-Control Studies; Child; Echocardiography; Endocrinopathies; Female; General aspects; Heart; Humans; Hypertension - blood; Hypertension - etiology; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pheochromocytoma - complications; Pheochromocytoma - surgery; Prospective Studies; Sex Distribution; Surgery; Treatment Outcome; Young Adult; Endocrinopathy; Human; Pheochromocytoma; Cardiomyopathy; Cure; Cardiovascular disease; Patient; Case control study; Catecholamine; Myocardial disease; Epidemiology; Result; Secretory tumor; Medicine; Prospective; Treatment; Dysfunction; Heart disease; Surgery; Reversibility; Circulatory system; Public health
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2011.09.001

Background Cardiovascular (CV) dysfunction and cardiomyopathy can cause perioperative morbidity in pheochromocytoma patients, but have not been studied systematically. This prospective, case-control study evaluated nature and extent of CV dysfunctions and their reversal following curative pheochromocytoma surgery. Methods Thirty-five pheochromocytoma patients, 9 normotensive nonpheochromocytoma adrenal tumors and 10 essential hypertensives were evaluated with 2-dimensional echocardiography, tissue Doppler, and serum N-terminal pro-brain natriuretic peptide (s-NTpro-BNP, a sensitive myocardial damage biomarker) serially before and after treatment. Results Pheochromocytoma patients had systolic and diastolic dysfunction, reduced left ventricular (LV) ejection fraction (EF), increased LV end-diastolic and systolic dimensions and volumes, myocardial performance index, and decreased transmitral early/late velocity ratio, which were worse compared with controls. All indices improved significantly with α-blockade and after pheochromocytoma resection, and normalized over 3-6 months. Tissue Doppler early velocity was lower ( P = .04) and s-NT-proBNP higher ( P = .0001) in pheochromocytoma patients compared with controls. Seven pheochromocytoma patients (20%) had significant LV dysfunction (LVEF <45%; s-NTpro-BNP levels >500 pg/mL) and had more marked postoperative improvement. Conclusion Global LV diastolic and systolic dysfunctions specific to pheochromocytoma are common and improve early postoperatively, with sustained improvement upon follow-up. Detailed cardiac evaluation with echocardiography, tissue Doppler, and s-NTpro-BNP may help to reduce perioperative morbidity and monitor recovery in pheochromocytoma patients.