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Effect of surgical treatment on myocardial strain in patients with pheochromocytoma and paraganglioma: a mini-review and meta-analysis

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Abstract

Aim

Information on systolic dysfunction, as assessed by left-ventricular (LV) mechanics, in patients with pheochromocytoma after surgical treatment is scanty. We performed a systematic meta-analysis of speckle tracking echocardiographic studies to provide an updated comprehensive information on this issue.

Methods

The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to May 31st 2021. Studies were identified using MeSH terms and crossing the following search items: “myocardial strain” “left ventricular mechanics”, “speckle tracking echocardiography”, “systolic dysfunction”, “pheochromocytoma”, and “paraganglioma”.

Results

A total of 92 surgically treated patients with pheochromocytoma/paraganglioma were included in 3 longitudinal studies. Successful surgical treatment was associated with a decrease in relative wall thickness (SMD − 0.25 ± 0.10, CI − 0.45/− 0.05, p < 0.01) and an improvement in global longitudinal strain (SMD − 0.45 ± 0.10, CI − 0.66/− 0.24, p < 0.0001). The favorable effects of treatment on LV geometry and mechanics were not accompanied by significant changes in ejection fraction (SMD − 0.07 ± 0.10, CI − 0.27/0.12, p = 0.44).

Conclusions

This meta-analysis adds a new piece of evidence, suggesting that surgical treatment of patients with pheochromocytoma impacts favorably on LV geometry and LV mechanics, and, more importantly, the assessment of LV changes in this setting can no longer rely on conventional echocardiographic parameters such as ejection fraction.

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References

  1. Januszewicz A, Lenders JWM, Eisenhofer G, Prejbisz A (2019) Pheocromocitoma and paraganglioma. In: Mancia G, Grassi G, Tsioufis KP, Dominiczak AF, Agabiti-Rosei E (eds) Manual of hypertension of the European Society of Hypertension. Taylor and Francis, pp 523–534

    Chapter  Google Scholar 

  2. Leung AA, Pasieka JL, Hyrcza MD, Pacaud D, Dong Y, Boyd JM, Sadrzadeh H (2021) Kline GA Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study. Eur J Endocrinol 184:19–28

    Article  CAS  Google Scholar 

  3. Falhammar H, Kjellman M, Calissendorff J (2018) Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect 7:186–192

    Article  CAS  Google Scholar 

  4. Y-Hassan S, Falhammar H (2020) Cardiovascular manifestations and complications of pheochromocytomas and paragangliomas. J Clin Med 9(8):2435

    Article  CAS  Google Scholar 

  5. Ferreira VM, Marcelino M, Piechnik SK, Marini C, Karamitsos TD, Ntusi NAB, Francis JM, Robson MD, Arnold JR, Mihai R, Thomas JDJ, Herincs M, Hassan-Smith ZK, Greiser A, Arlt W, Korbonits M, Karavitaki N, Grossman AB, Wass JAH, Neubauer S (2016) Pheochromocytoma is characterized by catecholamine-mediated myocarditis, focal and diffuse myocardial fibrosis, and myocardial dysfunction. J Am Coll Cardiol 67:2364–2374

    Article  CAS  Google Scholar 

  6. Zhou J, Xuan H, Miao Y, Hu J, Dai Y (2021) Acute cardiac complications and subclinical myocardial injuries associated with pheochromocytoma and paraganglioma. BMC Cardiovasc Disord 21(1):203

    Article  CAS  Google Scholar 

  7. Kvasnicka J, Zelinka T, Petrák O, Rosa J, Štrauch B, Krátká Z, Indra T, Markvartová A, Widimský J Jr, Holaj R (2019) Catecholamines induce left ventricular subclinical systolic dysfunction: a speckle-tracking echocardiography study. Cancers 11:318. https://doi.org/10.3390/cancers11030318

    Article  CAS  PubMed Central  Google Scholar 

  8. Park JH, Kim KS, Sul JY, Shin SK, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW (2011) Prevalence and patterns of left ventricular dysfunction in patients with pheochromocytoma. J Cardiovasc Ultrasound 19:76–82

    Article  Google Scholar 

  9. Saeed S, Tadic M, Grytaas M, Mancia M, Larsen TH (2021) The value of multimodality imaging in hypertensive heart disease. J Hypertens 39:1040–1043

    Article  CAS  Google Scholar 

  10. Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, Sengeløv M, Jørgensen PG, Mogelvang R, Shah AM, Jensen JS (2017) Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population: the Copenhagen City Heart Study. Circ Cardiovasc Imaging 10(3):e005521

    Article  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical research ed). 339:b2535

    Article  Google Scholar 

  12. Boulestreau R, Jambon F, Cremer A, Doublet J, Nunes ML, Ferrière A, Tabarin A, Haissaguerre M, Gosse P (2020) Chronic pheochromocytoma-induced myocardial injuries: what should we expect from modern and classical echocardiographic tools? Annales de Cardiologie et d’Angéiologie 69:241–246

    Article  CAS  Google Scholar 

  13. Dobrowolski P, Januszewicz A, Klisiewicz A, Gosk-Przybyłek M, Peczkowska M, Kabat M, Kwapiszewska A, Warchoł-Celinska E, Ambroziak U, Doroszko A, Toutounchi S, Gałazka Z, Bednarczuk T, Górnicka B, Januszewicz M, Hoffman P, Lenders JWM, Eisenhofer G, Prejbisz A (2020) Left ventricular structural and functional alterations in patients with pheochromocytoma/paraganglioma before and after surgery. JACC Cardiovasc Imaging 13:2499–2507

    Article  Google Scholar 

  14. Elenkova A, Shabani R, Kinova E, Vasilev V, Assen Goudev A, Zacharieva S (2020) Global longitudinal strain as a marker for systolic function in patients with pheochromocytomas. Endocr Relat Cancer 27:561–570

    Article  CAS  Google Scholar 

  15. Karlsen S, Dahlslett T, Grenne B, Sjøli B, Smiseth O, Edvardsen T, Brunvand H (2019) Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovasc Ultrasound 17(1):18

    Article  Google Scholar 

  16. Park JJ, Park JB, Park JH, Cho GY (2018) Global longitudinal strain to predict mortality in patients with acute heart failure. J Am Coll Cardiol 71:1947–1957

    Article  Google Scholar 

  17. Potter E, Marwick TH (2018) Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging 11(2 Pt 1):260–274

    Article  Google Scholar 

  18. Galderisi M, Esposito R, Schiano-Lomoriello V, Santoro A, Ippolito R, Schiattarella P, Strazzullo P, de Simone G (2012) Correlates of global area strain in native hypertensive patients: a three-dimensional speckle-tracking echocardiography study. Eur Heart J Cardiovasc Imaging 13:730–738

    Article  Google Scholar 

  19. Tadic M, Majstorovic A, Pencic B, Ivanovic B, Neskovic A, Badano L, Stanisavljevic D, Scepanovic R, Stevanovic P, Celic V (2014) The impact of high-normal blood pressure on left ventricular mechanics: a three-dimensional and speckle tracking echocardiography study. Int J Cardiovasc Imaging 30:699–711

    Article  Google Scholar 

  20. Ding L, Zhu WL, Zeng ZP, Li HZ, Ji J, Fang LG, Sun JP (2018) Subclinical left ventricular systolic dysfunction detected by two-dimensional speckle tracking echocardiography in patients with pheochromocytoma and paraganglioma and preserved ejection fraction. Echocardiography 35:184–189

    Article  Google Scholar 

  21. Kvasnička J, Zelinka T, Petrák O, Rosa J, Štrauch B, Krátká Z, Indra T, Markvartová A, Widimský J Jr, Holaj R (2019) Catecholamines induce left ventricular subclinical systolic dysfunction: a speckle-tracking echocardiography study. Cancers (Basel) 11(3):318

    Article  Google Scholar 

  22. Y-Hassan S, Falhammar H (2020) Cardiovascular manifestations and complications of pheochromocytomas and paragangliomas. J Clin Med 9(8):2435

    Article  CAS  Google Scholar 

  23. Zuber SM, Kantorovich V, Pacak K (2011) Hypertension in pheochromocytoma: characteristics and treatment. Endocrinol Metab Clin North Am 40:295–311

    Article  CAS  Google Scholar 

  24. Tadic M, Cuspidi C, Majstorovic A, Pencic B, Mancia G, Bombelli M, Grassi G, Kocijancic V, Djukic V, Celic V (2020) The association between 24-h blood pressure patterns and left ventricular mechanics. J Hypertens 38:282–288

    Article  CAS  Google Scholar 

  25. Petrák O, Rosa J, Holaj R, Štrauch B, Krátká Z, Kvasnička J, Klímová J, Waldauf P, Hamplová B, Markvartová A, Novák K, Michalský D, Widimský J, Zelinka T (2019) Blood pressure profile, catecholamine phenotype, and target organ damage in pheochromocytoma/paraganglioma. J Clin Endocrinol Metab 104:5170–5180

    Article  Google Scholar 

  26. Van Vliet PD, Burchell HB, Titus JL (1966) Focal myocarditis associated with pheochromocytoma. N Engl J Med 274:1102–1108

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, University Hospital “Dr. Dragisa Misovic-Dedinje”, Heroja Milana Tepica 1, 11000, Belgrade, Serbia

    M. Tadic

  2. Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico Di Milano, Milan, Italy

    C. Sala & S. Carugo

  3. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    C. Cuspidi

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  1. M. Tadic
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  2. C. Sala
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  3. S. Carugo
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  4. C. Cuspidi
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Correspondence to M. Tadic.

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Tadic, M., Sala, C., Carugo, S. et al. Effect of surgical treatment on myocardial strain in patients with pheochromocytoma and paraganglioma: a mini-review and meta-analysis. J Endocrinol Invest 44, 2327–2332 (2021). https://doi.org/10.1007/s40618-021-01631-3

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  • DOI: https://doi.org/10.1007/s40618-021-01631-3

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