Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Impact of Pheochromocytoma on Left Ventricular Hypertrophy and QTc Prolongation: Comparison with Takotsubo Cardiomyopathy

  • Choi, Seon Yoon (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • Cho, Kyoung Im (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • Han, You Jin (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • You, Ga In (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • Kim, Je Hun (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • Heo, Jeong Ho (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • Kim, Hyun Soo (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • Cha, Tae Joon (Cardiovascular Research Institute, Kosin University School of Medicine) ;
  • Lee, Jae Woo (Cardiovascular Research Institute, Kosin University School of Medicine)
  • Received : 2013.08.20
  • Accepted : 2014.01.23
  • Published : 2014.02.28
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Abstract

Background and Objectives: Excessive catecholamine causes the alteration of cardiac structure and function. This study evaluated if there is any difference in left ventricular hypertrophy (LVH) and QTc prolongation in conditions with pheochromocytoma and Takotsubo cardiomyopathy (TC). Subjects and Methods: We reviewed the medical records of 20 pheochromocytoma patients for cardiovascular events prior to diagnosis. The patient's clinical history and electrocardiographic and echocardiographic findings were compared to those of 20 patients diagnosed with TC. Results: Left ventricular (LV) mass index ($133.3{\pm}37.8$ vs. $113.3{\pm}17.3$, p=0.031), relative wall thickness ($0.55{\pm}0.15$ vs. $0.47{\pm}0.07$, p=032) and elevated blood pressure (BP) were more prominent in pheochromocytoma compared to TC. The mean creatinine kinase-MB elevation, reduced LV systolic function and ST segment changes were more prominent in the TC group compared to the pheochromocytoma groups (all p<0.05). The prevalence of QTc prolongation was high in patients with pheochromocytoma (45%) and TC (55%), and TC male patients appeared to have a more prolonged QTc interval. Urine epinephrine (r=0.844, p=0.004) and norepinephrine level (r=0.782, p=0.013) were significantly correlated with LV mass index, and the predictors for the QTc prolongation were male gender and the presence of LVH. Conclusion: A prolonged QTc was prominent in pheochromocytoma and TC regardless of BP and systolic LV function, and LVH was more prominent in pheochromocytoma than TC.

Keywords

References

  1. Whalen RK, Althausen AF, Daniels GH. Extra-adrenal pheochromocytoma. J Urol 1992;147:1-10. https://doi.org/10.1016/S0022-5347(17)37119-7
  2. Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab 2005;90:2110-6. https://doi.org/10.1210/jc.2004-1398
  3. Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A. Cardiovascular manifestations of phaeochromocytoma. J Hypertens 2011;29:2049-60. https://doi.org/10.1097/HJH.0b013e32834a4ce9
  4. Leite LR, Macedo PG, Santos SN, Quaglia L, Mesas CE, De Paola A. Lifethreatening cardiac manifestations of pheochromocytoma. Case Rep Med 2010;2010:976120.
  5. Sacha J, Wester A, Hordynski G, Pluta W. QT interval prolongation during ECG evolution in takotsubo cardiomyopathy poses a threat of torsade de pointes to predisposed patients. Case report of a female patient with congenital AV block. Herz 2013;38:790-5. https://doi.org/10.1007/s00059-013-3756-8
  6. van der Heide K, de Haes A, Wietasch GJ, Wiesfeld AC, Hendriks HG. Torsades de pointes during laparoscopic adrenalectomy of a pheochromocytoma: a case report. J Med Case Rep 2011;5:368. https://doi.org/10.1186/1752-1947-5-368
  7. Chakraborty P, Bhattacharjeee HK, Anandaraja S. Palpitition, presyncope and abdominal mass. Indian Heart J 2010;62:447-8.
  8. Takizawa M, Kobayakawa N, Uozumi H, et al. A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy. Int J Cardiol 2007;114:e15-7. https://doi.org/10.1016/j.ijcard.2006.07.125
  9. Agarwal V, Kant G, Hans N, Messerli FH. Takotsubo-like cardiomyopathy in pheochromocytoma. Int J Cardiol 2011;153:241-8.
  10. Matsuoka K, Okubo S, Fujii E, et al. Evaluation of the arrhythmogenecity of stress-induced "Takotsubo cardiomyopathy" from the time course of the 12-lead surface electrocardiogram. Am J Cardiol 2003;92:230-3. https://doi.org/10.1016/S0002-9149(03)00547-2
  11. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-8. https://doi.org/10.1016/0002-9149(86)90771-X
  12. Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992;19:1550-8. https://doi.org/10.1016/0735-1097(92)90617-V
  13. Hannan PJ, Crow RS. Concerning the units for the QT interval corrected by Bazett's formula. Circulation 1997;96:3799.
  14. Gifford RW Jr, Bravo EL, Manger WM. Diagnosis and management of pheochromocytoma. Cardiology 1985;72 Suppl 1:126-30. https://doi.org/10.1159/000173958
  15. Giavarini A, Chedid A, Bobrie G, Plouin PF, Hagege A, Amar L. Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma. Heart 2013;99:1438-44. https://doi.org/10.1136/heartjnl-2013-304073
  16. Zelinka T, Petrak O, Turkova H, et al. High incidence of cardiovascular complications in pheochromocytoma. Horm Metab Res 2012;44:379-84. https://doi.org/10.1055/s-0032-1306294
  17. Eisenhofer G, Rivers G, Rosas AL, Quezado Z, Manger WM, Pacak K. Adverse drug reactions in patients with phaeochromocytoma: incidence, prevention and management. Drug Saf 2007;30:1031-62. https://doi.org/10.2165/00002018-200730110-00004
  18. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation 2008;118:397-409. https://doi.org/10.1161/CIRCULATIONAHA.106.677625
  19. Kaese S, Schulke C, Fischer D, Lebiedz P. Pheochromocytoma-induced takotsubo-like cardiomyopathy and global heart failure with need for extracorporal life support. Intensive Care Med 2013;39:1473-4. https://doi.org/10.1007/s00134-013-2942-8
  20. Radtke WE, Kazmier FJ, Rutherford BD, Sheps SG. Cardiovascular complications of pheochromocytoma crisis. Am J Cardiol 1975;35:701-5. https://doi.org/10.1016/0002-9149(75)90060-0
  21. Kelm M, Schafer S, Mingers S, et al. Left ventricular mass is linked to cardiac noradrenaline in normotensive and hypertensive patients. J Hypertens 1996;14:1357-64. https://doi.org/10.1097/00004872-199611000-00015
  22. Simpson P. Norepinephrine-stimulated hypertrophy of cultured rat myocardial cells is an alpha 1 adrenergic response. J Clin Invest 1983;72:732-8. https://doi.org/10.1172/JCI111023
  23. Fouad-Tarazi FM, Imamura M, Bravo EL, et al. Differences in left ventricular structural and functional changes between pheochromocytoma and essential hypertension. Role of elevated circulating catecholamines. Am J Hypertens 1992;5:134-40. https://doi.org/10.1093/ajh/5.3.134
  24. Shub C, Cueto-Garcia L, Sheps SG, Ilstrup DM, Tajik AJ. Echocardiographic findings in pheochromocytoma. Am J Cardiol 1986;57:971-5. https://doi.org/10.1016/0002-9149(86)90741-1
  25. Goldbaum TS, Henochowicz S, Mustafa M, Blunda M, Lindsay J Jr. Pheochromocytoma presenting with Prinzmetal's angina. Am J Med 1986;81:921-2.
  26. Cheng TO, Bashour TT. Striking electrocardiographic changes associated with pheochromocytoma. Masquerading as ischemic heart disease. Chest 1976;70:397-9. https://doi.org/10.1378/chest.70.3.397
  27. Yu R, Nissen NN, Bannykh SI. Cardiac complications as initial manifestation of pheochromocytoma: frequency, outcome, and predictors. Endocr Pract 2012;18:483-92. https://doi.org/10.4158/EP11327.OR
  28. Ahn JH, Park SH, Shin WY, et al. Long QT syndrome and torsade de pointes associated with Takotsubo cardiomyopathy. J Korean Med Sci 2011;26:959-61. https://doi.org/10.3346/jkms.2011.26.7.959
  29. Insulander P, Vallin H. Gender differences in electrophysiologic effects of mental stress and autonomic tone inhibition: a study in health individuals. J Cardiovasc Electrophysiol 2005;16:59-63. https://doi.org/10.1046/j.1540-8167.2005.04117.x
  30. Panikkath R, Reinier K, Uy-Evanado A, et al. Electrocardiographic predictors of sudden cardiac death in patients with left ventricular hypertrophy. Ann Noninvasive Electrocardiol 2013;18:225-9. https://doi.org/10.1111/anec.12003

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