Author + information
- Received January 31, 2020
- Revision received July 21, 2020
- Accepted July 23, 2020
- Published online September 16, 2020.
- Piotr Dobrowolski, MD, PhDa,∗ (, )
- Andrzej Januszewicz, MD, PhDa,
- Anna Klisiewicz, MD, PhDb,
- Maria Gosk-Przybyłek, MDa,
- Mariola Pęczkowska, MD, PhDa,
- Marek Kabat, MD, PhDa,
- Aleksandra Kwapiszewska, MDa,
- Ewa Warchoł-Celińska, MD, PhDa,
- Urszula Ambroziak, MD, PhDc,
- Adrian Doroszko, MD, PhDd,
- Sadegh Toutounchi, MD, PhDe,
- Zbigniew Gałązka, MD, PhDe,
- Tomasz Bednarczuk, MD, PhDc,
- Barbara Górnicka, MD, PhDf,
- Magdalena Januszewicz, MD, PhDa,
- Piotr Hoffman, MD, PhDb,
- Jacques W.M. Lenders, MD, PhDg,h,
- Graeme Eisenhofer, MD, PhDg,i and
- Aleksander Prejbisz, MD, PhDa
- aDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
- bDepartment of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
- cDepartment of Internal Diseases and Endocrinology, Medical University of Warsaw, Warsaw, Poland
- dDepartment of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
- eDepartment of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland
- fDepartment of Pathology, Medical University of Warsaw, Warsaw, Poland
- gDepartment of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- hDepartment of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- iInstitute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
- ↵∗Address for correspondence:
Dr. Piotr Dobrowolski, Department of Hypertension, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.
Objectives This study sought to evaluate left ventricular (LV) structure and function in pheochromocytoma and paraganglioma (PPGL) patients before and after curative surgery.
Background Data on catecholamine-induced effects on LV structure and function in patients with PPGL are limited and conflicting.
Methods The study evaluated 81 consecutive patients with a PPGL, among whom 66 were evaluated 12 months after tumor removal. Fifty patients matched for age, sex, hypertension presence, and blood pressure (BP) levels served as a control group (non-PPGL group). Echocardiography was employed to assess the LV mass index (LVMI), systolic function including speckle tracking echocardiography, and diastolic function.
Results Patients with PPGL were characterized by higher LVMI (median 103 [interquartile range (IQR): 88 to 132] g/m2 vs. median 94 [IQR: 74 to 106] g/m2; p = 0.006) and frequency of LV hypertrophy (44.4% vs. 24.0%; p = 0.018) compared with the non-PPGL group. Patients with PPGLs were characterized by lower global longitudinal strain (GLS) and early diastolic mitral annular velocity compared with patients in the non-PPGL group (median –17.2% [IQR: 15.6% to 18.9%] vs. median –19.3% [IQR: 17.7% to 20.6%]; p < 0.001; and median 11.1 [IQR: 8.3 to 13.0] cm/s vs. median 12.3 [IQR: 10.6 to 14.6] cm/s; p = 0.018, respectively). Presence of LV hypertrophy and GLS were independently associated with plasma free metanephrine concentrations. In operated patients, there were lower frequencies of LV hypertrophy (39.4% vs. 22.7%; p = 0.003), LVMI (median 98 [IQR: 85 to 115] g/m2 vs. median 90 [IQR: 76 to 109] g/m2; p < 0.001), and the ratio of transmitral early diastolic velocity to early diastolic mitral annular velocity (median 6.8 [IQR: 5.5 to 8.6] vs. median 6.0 [IQR: 5.0 to 7.6]; p = 0.005) but higher values for GLS (median –17.4 [IQR: –15.8 to 19.1] vs. median −18.5 [IQR: –17.1 to 20.1] p < 0.001) after compared with before surgery.
Conclusions Catecholamine excess in patients with PPGLs can lead not only to LV hypertrophy, but also to impairment of systolic LV function and subclinical alterations of diastolic LV function, independently of BP levels. These structural and functional changes are reversible after surgical intervention.
- global longitudinal strain
- left ventricular function
- pheochromocytomas and paragangliomas
The study was supported by the grant of the Ministry of Science (Warsaw, Poland) (no. NN402386038; to Dr. Januszewicz) and the German Research Foundation (Project no. 314061271-TRR 205/1; to Dr. Eisenhofer). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received January 31, 2020.
- Revision received July 21, 2020.
- Accepted July 23, 2020.
- 2020 American College of Cardiology Foundation
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