INTERVENTIONAL THERAPIES IN CARCINOID HEART DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Main Article Content

Shakirat Ganiyu
Umar Khatab
Manzoor Ullah
Zobia Aslam
Mehar Masood
Kaleem Ahmad

Keywords

Carcinoid heart disease, Interventional therapies, Neuroendocrine tumors

Abstract

Carcinoid heart disease is a rarely occurring cardiac manifestation that typically affects the right-sided heart valves and ultimately results in right heart failure, and it occurs in patients with advanced neuroendocrine tumors and the carcinoid syndrome. Online databases such as Midline, Google Scholar, and the PubMed databases, were searched using the following methodology to find papers regarding the therapies of carcinoid heart disease. Relevant publications were evaluated for study quality and evaluate by independent reviewers. Treatment type was taken into account when stratifying the meta-analysis of the intervention's effects on symptoms connected to carcinoid heart disease. 3682 treatment interventions on outcomes unique to carcinoid heart disease were gathered from 93 research, according to our results. The study's overall quality was poor because it included just six randomized controlled clinical studies. Octreotide and lanreotide, two somatostatin analogs, improved symptoms in 65–72% of patients and caused a biochemical response in 45–46% of them. In 72–84% of cases, flushes and/or diarrhea were reduced as a result of an increase in dosage, frequency, or interclass transition. In 82% of carcinoid heart disease patients with a liver-dominant disease, liver-directed therapy can alleviate symptoms, according to a retrospective institutional series. 40 percent of patients with diarrhea resistant to somatostatin analogs experienced a reduction in bowel movements after taking the serotonin synthesis inhibitor telotristat ethyl. In 45–63% of instances, interferon-alpha was able to control the carcinoid heart disease symptoms. After radionuclide therapy, favorable response has been shown in subgroup analyses of studies that do not explicitly involve patients with carcinoid heart disease. In the carcinoid heart disease, chemotherapy and everolimus did not provide a noticeable effect. We conclude that patients with carcinoid heart disease can get numerous courses of treatment. It is highly recommended to start randomized controlled studies using carcinoid heart disease symptoms as the primary outcome.

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References

1. Bober B, Saracyn M, Kołodziej M, Kowalski Ł, Deptuła-Krawczyk E, Kapusta W, et al. Carcinoid heart disease: how to diagnose and treat in 2020? Clinical Medicine Insights: Cardiology. 2020;14:1179546820968101.
2. Ram P, Penalver JL, Lo KBU, Rangaswami J, Pressman GS. Carcinoid heart disease: review of current knowledge. Texas Heart Institute Journal. 2019;46(1):21-7.
3. Jin C, Sharma AN, Thevakumar B, Majid M, Al Chalaby S, Takahashi N, et al. Carcinoid heart disease: pathophysiology, pathology, clinical manifestations, and management. Cardiology. 2021;146(1):65-73.
4. Oleinikov K, Korach A, Planer D, Gilon D, Grozinsky-Glasberg S. Update in carcinoid heart disease-the heart of the matter. Reviews in Endocrine and Metabolic Disorders. 2021:1-9.
5. Hassan SA, Palaskas NL, Agha AM, Iliescu C, Lopez-Mattei J, Chen C, et al. Carcinoid heart disease: a comprehensive review. Current Cardiology Reports. 2019;21:1-7.
6. Perry D, Hayek SS. Carcinoid heart disease: a guide for clinicians. Cardiology clinics. 2019;37(4):497-503.
7. Davar J, Lazoura O, Caplin ME, Toumpanakis C. Features of carcinoid heart disease identified by cardiac computed tomography. Journal of Cardiovascular Computed Tomography. 2021;15(2):167-74.
8. Levy S, Korse CE, de Groot AC, Meijer RC, Tesselaar ME, Valk GD. Four decades of experience with carcinoid heart disease: An analysis of 84 patients. Journal of Neuroendocrinology. 2022;34(10):e13199.
9. Baron T, Bergsten J, Albåge A, Lundin L, Sörensen J, Öberg K, et al. Cardiac imaging in carcinoid heart disease. Cardiovascular Imaging. 2021;14(11):2240-53.
10. Pęczkowska M, Konsek-Komorowska SJ, Kolasińska-Ćwikła AD, Konka M, Michałowska I, Ćwikła JB. What do we know about carcinoid heart disease in the present era? Kardiologia Polska (Polish Heart Journal). 2022;80(10):990-1001.
11. Macfie R, McCully BH, Ratzlaff AN, Lim J, Song HK, Dewey EN, et al. The prevalence, operations, and outcomes of carcinoid heart disease. The American Journal of Surgery. 2022;224(2):665-9.
12. Baron E, Szymanski C, Hergault H, Lepère C, Dubourg O, Hauguel‐Moreau M, et al. Progression of carcinoid heart disease in the modern management era. Journal of the American Heart Association. 2021;10(23):e020475.
13. Moher D, Liberati A, Tetzlaff J, Altman DG, Group* P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009;151(4):264-9.
14. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews. 2015;4:1-9.
15. Arnold R, Rinke A, Klose K-J, Müller H-H, Wied M, Zamzow K, et al. Octreotide versus octreotide plus interferon-alpha in endocrine gastroenteropancreatic tumors: a randomized trial. Clinical Gastroenterology and Hepatology. 2005;3(8):761-71.
16. Suc G, Cachier A, Hentic O, Bazire B, Sannier A, Delhomme C, et al. Management and outcomes of Carcinoid heart disease with liver metastases of Midgut Neuroendocrine tumours. Heart. 2024;110(2):132-9.
17. Grozinsky‐Glasberg S, Davar J, Hofland J, Dobson R, Prasad V, Pascher A, et al. European neuroendocrine tumor society (ENETS) 2022 guidance paper for carcinoid syndrome and carcinoid heart disease. Journal of Neuroendocrinology. 2022;34(7).
18. Koffas A, Toumpanakis C, editors. Managing carcinoid heart disease in patients with neuroendocrine tumors. Annales d'Endocrinologie; 2021: Elsevier.
19. Nistor CE, Carsote M, Ranetti AE, Ciuche A. Carcinoid Heart Disease–A 2022 Retrospective. Romanian Journal of.126(2):211.
20. Barnebee D, Morse B, Strosberg JR, Pejic M, Jeong D. Cardiac magnetic resonance for diagnosis of neuroendocrine tumor metastases to the right and left ventricles with carcinoid heart disease. Case Reports in Cardiology. 2019;2019.
21. Khan SA, Devkota D, Chaudhary RK, Luitel A, Parajuli SB, Bista M, et al. Molecular biology of carcinoid heart disease: Seeking therapeutic targets in the era of targeted therapy. Medicine. 2023;102(47):e36043.
22. Mikail N, Pisani A, El Hatimi S, Hentic O, Lebtahi R, Poitier B, et al. Early Diagnosis and Treatment of Myocardial Neuroendocrine Tumor Metastasis: The Cornerstone Role of Multimodality Imaging. Circulation: Cardiovascular Imaging. 2021;14(4):e011857.
23. Koumarianou A, Daskalakis K, Tsoli M, Kaltsas G, Pavel M. Efficacy, safety and unmet needs of evolving medical treatments for carcinoid syndrome. Journal of Neuroendocrinology. 2022;34(7):e13174.
24. Honan KA, Hassan S, Deswal A, Herrmann J, Song J, Monlezun D, et al. Bioprosthetic valve monitoring in patients with carcinoid heart disease. Frontiers in Cardiovascular Medicine. 2023;9:1072890.
25. Keskin O, Yalcin S. Carcinoid crisis in the intensive care unit. Oncologic Critical Care. 2020:995-1001.
26. Mattig I, Franke MR, Pschowski R, Brand A, Stangl K, Knebel F, et al. Prevalence, one-year-incidence and predictors of carcinoid heart disease. Cardiovascular Ultrasound. 2023;21(1):18.
27. Bdiwi M, Ramaseshan K, Uddin M, Goel M, Razzaq S, Alrayyashi M, et al. Carcinoid heart disease: a potentially fatal complication of carcinoid syndrome. BMJ Case Reports CP. 2023;16(12):e255518.
28. Alvarez-Villegas D, Giménez-Milà M, Sbraga F, Camprubí I, Gil A. WITHDRAWN: Dealing With the Right Side: Carcinoid Heart Disease. Journal of cardiothoracic and vascular anesthesia. 2022;36(7):2228-31.
29. Kudelka MR, Abou-Alfa GK, O’Reilly EM, Foote MB, Sirohi B, Elias R, et al. Metastatic well differentiated serotonin-producing pancreatic neuroendocrine tumor with carcinoid heart disease: a case report. Journal of Gastrointestinal Oncology. 2023;14(4):1878.
30. Graf J, Pape U-F, Jann H, Denecke T, Arsenic R, Brenner W, et al. Prognostic significance of somatostatin receptor heterogeneity in progressive neuroendocrine tumor treated with Lu-177 DOTATOC or Lu-177 DOTATATE. European Journal of Nuclear Medicine and Molecular Imaging. 2020;47:881-94.
31. Schüttler D, Mourouzis K, Auernhammer CJ, Rizas KD. Development of severe intrapulmonary shunting in a patient with carcinoid heart disease after closure of a persistent foramen ovale: a case report. European Heart Journal-Case Reports. 2021;5(12):ytab494.
32. Rabei R, Fidelman N. Liver-Directed Therapy for Neuroendocrine Tumor Metastases in the Era of Peptide Receptor Radionuclide Therapy. Current Treatment Options in Oncology. 2023:1-11.
33. Ebbers S, Barentsz M, de Vries-Huizing D, Versleijen M, Klompenhouwer E, Tesselaar M, et al. Intra-arterial peptide-receptor radionuclide therapy for neuro-endocrine tumour liver metastases: an in-patient randomised controlled trial (LUTIA). European Journal of Nuclear Medicine and Molecular Imaging. 2023:1-12.
34. Fanciulli G, Ruggeri RM, Grossrubatscher E, Calzo FL, Wood TD, Faggiano A, et al. Serotonin pathway in carcinoid syndrome: Clinical, diagnostic, prognostic and therapeutic implications. Reviews in Endocrine and Metabolic Disorders. 2020;21:599-612.
35. Faidon-Marios L, Davar J, Christos T. Carcinoid Heart Disease: a Review. Current Oncology Reports. 2021;23(4).
36. Bader M. Inhibition of serotonin synthesis: A novel therapeutic paradigm. Pharmacology & therapeutics. 2020;205:107423.
37. Bell J, Alhudairy M, Kazakova V, Tsao L, Johnstone M. REFRACTORY HEART FAILURE-A RARE CASE OF CONCOMINANT RIGHT AND LEFT-SIDED CARCINOID HEART DISEASE IN THE SETTING OF SELECTIVE SERETONIN RECEPTOR INHIBITOR USE. Journal of the American College of Cardiology. 2020;75(11_Supplement_1):3270-.
38. Magi L, Rinzivillo M, Panzuto F. What gastroenterologists should know about carcinoid syndrome. Gastroenterology Insights. 2022;13(1):127-38.
39. Herrera-Martínez AD, Feelders RA, Van den Dungen R, Dogan-Oruc F, van Koetsveld PM, Castaño JP, et al. Effect of the tryptophan hydroxylase inhibitor telotristat on growth and serotonin secretion in 2D and 3D cultured pancreatic neuroendocrine tumor cells. Neuroendocrinology. 2020;110(5):351-63.
40. Rieder M, Gauchel N, Bode C, Duerschmied D. Serotonin: a platelet hormone modulating cardiovascular disease. Journal of thrombosis and thrombolysis. 2021;52(1):42-7.
41. Pandit S, Annamaraju P, Bhusal K. Carcinoid syndrome. StatPearls [Internet]: StatPearls Publishing; 2023.
42. Hameed T, Kumar A, Singh CB. Carcinoid Tumors: from the Past into the Future. Maedica. 2021;16(4):695.

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