Carcinoid Heart Disease

Abstract

Møller et al. (March 13 issue)¹ addressed the topic of the progression of carcinoid heart disease. Serial echocardiographic studies were available for 71 of the 273 referred patients. The median level of urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion at base line in patients with carcinoid heart disease was 209 mg per 24 hours, and in those without carcinoid heart disease it was 110 mg per 24 hours; the median duration of the syndrome was relatively short, at 1.0 and 1.8 years, respectively. Remarkably, data on 5-HIAA levels during the course of this disease are scarce. We therefore studied 73 patients with the carcinoid syndrome who were referred between 1985 and 2002, in whom the 5-HIAA level was measured at one-year intervals. The median urinary 5-HIAA level gradually increased, reaching 110 mg per 24 hours only after more than seven years had passed ( Figure 1 ). The very high urinary 5-HIAA levels and the high incidence of carcinoid heart disease relative to that in another recent study² suggest that Møller et al. studied a highly selected group. This underscores that although somatostatin analogues did not prevent carcinoid heart disease in their population, a beneficial effect is not precluded in less advanced disease.