Activin A in Carcinoid Heart Disease: A Possible Role in Diagnosis and Pathogenesis Abstract #356

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Introduction: Carcinoid heart disease (CHD) is a known complication of neuroendocrine tumors (NETs), particularly of those arising from the small intestine, appendix and proximal colon (previously known as mid-gut carcinoids). CHD is characterized by right heart fibrotic lesions and has traditionally been defined by the degree of valvular involvement, most commonly in the form of tricuspid regurgitation. Right ventricular (RV) dysfunction due to mural involvement may also be a manifestation. Connective tissue growth factor (CCN2) is upregulated in many fibrotic disorders. Increased tumor expression of CCN2 has been shown in patients with small intestinal NETs associated with peritoneal fibrosis. At present, its role in carcinoid heart disease is unknown.
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#2833 Surgical Correction of Carcinoid Heart Disease Improves Liver Function and 5-Hydroxyindoleacetic Acid Levels
Introduction: Neuroendocrine tumours of the gastrointestinal tract cause carcinoid syndrome and carcinoid heart disease. These tumours secrete serotonin, which can bind to heart valves and cause fibrosis and valve incompetence. Most cases involve the tricuspid valve +/- pulmonary valve. Medical management comprises diuretics for fluid overload and somatostatin analogues to reduce circulating serotonin. Definitive treatment is heart-valve replacement surgery which improves exercise tolerance but has high perioperative mortality. We have previously reported that valve-replacement surgery can reduce 5-hydroxyindoleacetic acid (5-HIAA) levels, reflecting a decline in hormone activity.
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#2944 Soluble ST2 (sST2) Levels in the Management of Carcinoid Heart Disease in Patients with Neuroendocrine Cancer
Introduction: The identification of a sensitive biomarker to detect the presence and severity of carcinoid heart disease could allow more selective use of clinical and echocardiographic screening. ST2 is a protein belonging to the family of interleukin 1 receptors, present both in the isoform of transmembrane (ST2L) and in the soluble one (sST2). sST2 blocks the anti-inflammatory, anti-hypertrophic, and anti-fibrotic effects of cytokine IL-33 on the myocardium and recent studies have shown that sST2 levels increase in the blood of patients diagnosed with heart failure.
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