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You are here: Contents > 2013 > Volume 22 Number 3 May 2013 > MISCELLANEOUS > Circulating Plasma and Platelet 5-Hydroxytryptamine in Carcinoid Heart Disease: A Pilot Study

Circulating Plasma and Platelet 5-Hydroxytryptamine in Carcinoid Heart Disease: A Pilot Study

Sanjeev Bhattacharyya1, Anita Jagroop2, Dorothy M. Gujral3, Carl Hayward1, Christos Toumpanakis3, Martyn Caplin3, Dimitri P. Mikhailidis2, Joseph Davar1

1Department of Cardiology, Royal Free Hospital, London, 2Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, 3Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK

Background and aim of the study: Carcinoid heart disease (CaHD) is a rare form of valvular heart disease in patients with carcinoid syndrome (CS). The role of 5-hydroxytryptamine (5-HT) in the pathogenesis of CaHD is unclear. The study aim was to evaluate the association between platelet 5-HT (5-HTplt) and plasma 5-HT (5-HTpls) and valvular dysfunction.

Methods: Twelve patients with CaHD, 18 with CS and 10 ‘normal’ subjects were recruited. Patients with CaHD underwent cardiac catheterization and echocardiography. 5-HTplt and 5-HTpls was sampled in blood from the femoral vein, right and left ventricle, and left antecubital fossa vein.

Results: Levels of 5-HTpls and 5-HTplt were significantly higher in patients with CaHD (median 5-HTpls 325 nmol/l and 5-HTplt 18.9 nmol/109 platelets) and CS (median 5-HTpls 155 nmol/l and 5-HTplt 16.4 nmol/109

platelets) when compared to healthy controls (median 5-HTpls 9 nmol/l and 5-HTplt 3.7 nmol/109 platelets; p <0.0001 and p = 0.003, respectively). There was a significant increase in 5-HTplt and 5-HTpls between the femoral vein and right heart (p = 0.007 and p = 0.0002, respectively). There was no significant difference in 5-HTplt or 5-HTpls between the right and left side of the heart, irrespective of the presence of a patent foramen ovale or of left-sided CaHD.

Conclusion: Plasma and platelet 5-HT levels are elevated in patients with CaHD. Despite exposure to similar levels of intracardiac plasma and platelet 5-HT, the development of valve dysfunction is heterogeneous. This suggests that individual heart valves have a susceptibility to the development of valvular dysfunction which is not related solely to plasma or platelet 5-HT levels.

The Journal of Heart Valve Disease 2013;22:400-407

Circulating Plasma and Platelet 5-Hydroxytryptamine in Carcinoid Heart Disease: A Pilot Study

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