Clinical and echocardiographic characteristics of neuroendocrine tumours and carcinoid heart disease: insights from a contemporary canadian cohort study
Notice bibliographique
Résumé
Abstract Background Neuroendocrine tumours (NETs) are uncommon cancers that can secrete vasoactive hormones, causing a range of symptoms. Approximately 50% of metastatic small bowel NETs develop carcinoid syndrome, with up to 50% historically developing carcinoid heart disease (CHD). With advances in medical therapy, contemporary characteristics and prognosis of CHD are unclear. Purpose To evaluate clinical characteristics, echocardiographic features, and outcomes of patients with NETs and CHD in a contemporary Canadian cohort and identify factors associated with CHD development and mortality. Methods This retrospective cohort study analyzed patients undergoing echocardiograms at a tertiary cancer centre-affiliated laboratory (2013-2023) with references to NETs or CHD in reports. Patients were classified based on whether they did or did not develop CHD in the study period. Baseline clinical characteristics, treatments, and outcomes were compared between the two groups. Baseline echocardiographic data (≤6 months from NET diagnosis) were reviewed to characterize features associated with CHD development. Interventions were compared between patients who survived <2.5 years after CHD diagnosis and those who survived ≥2.5 years or were alive by the end of the study period. Results In this 10-year period, 87 patients with NETs were identified [42 (48%) female; median age 61 (IQR 53-69) years] and 18 (21%) developed CHD [8 (44%) female; median age 66 (IQR 59-71) years]. Primary NETs of small bowel origin were more common in patients with CHD than those without CHD (83% vs. 55%, p=0.032). CHD patients exclusively had right-sided valve involvement: 100% tricuspid and 61% pulmonary; 2 (11%) had a patent foramen ovale. Compared to non-CHD patients at baseline echo, CHD patients demonstrated higher mean right atrial volume index (41mL/m2 vs 24mL/m2, p=0.001), higher mean right ventricular (RV) basal diameter (40mm vs. 34mm, p=0.006), and more frequent RV dysfunction (22% vs. 0%, p<0.001). Surgical valve replacement was performed in 9 (50%) CHD patients and was indicated but deferred in 6 (33%) due to competing comorbidities. The median survival of CHD patients was 2.4 vs. 13.4 years without CHD (p<0.001). NET progression and refractory heart failure were main reasons for mortality. Among CHD patients, primary NET resection was significantly associated with improved survival (p=0.009). Tyrosine kinase inhibitors and radiation therapy showed trends toward improved survival. Conclusions In our cohort of patients with NETs, CHD prevalence was lower than previously reported with all cases affecting only right-sided valves. Over half developed an indication for valve replacement though many were ineligible. Contemporary therapeutics, including medical and radiation therapies, showed trends toward improved survival. Further studies are needed to determine reasons behind differences in CHD prevalence, valvular involvement, and outcomes in the current era.Study design and findings Table 1.Clinical and echo data
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».