Cardiac Imaging in Carcinoid Heart Disease.

Carcinoid disease is caused by neuroendocrine tumors, most often located in the gut, and leads in approximately 20% of cases to specific, severe heart disease, most prominently affecting right-sided valves. If cardiac disease occurs, it determines the patient's prognosis more than local growth of the tumor. Surgical treatment of carcinoid-induced valve disease has been found to improve survival in observational studies. Cardiac imaging is crucial for both diagnosis and management of carcinoid heart disease; in the past, imaging was accomplished largely by echocardiography, but more recently, imaging for carcinoid heart disease has increasingly become multimodal and warrants awareness of the particular diagnostic challenges of this disease. This paper reviews the pathophysiology and manifestations of carcinoid heart disease in light of the different imaging modalities. [Display omitted] • Carcinoid heart disease is a complication of metastatic neuroendocrine tumors of the gut affecting mainly the tricuspid and pulmonary valves and rarely also the mitral and aortic valves. • Adequate cardiac imaging is crucial for diagnosis and for the decision to intervene surgically, which has been shown to improve prognosis in severe carcinoid heart disease. • Carcinoid heart disease displays specific, well-recognized features which should be systematically sought in patients with known tumors or right-sided valvular heart disease. • Pulmonary valve involvement is frequent, tends to be underestimated by echocardiography, and may require cardiac magnetic resonance for complete evaluation. • Cardiac computed tomography and nuclear imaging can contribute to improved evaluation in some cases. [ABSTRACT FROM AUTHOR]