Background: Catecholamine-induced cardiomyopathy in pheochromocytoma patients represents a model of stress-induced cardiomyopathy with a predominantly reversible course after successful tumor extirpation. Echocardiographic strain imaging is a relatively new non-invasive method which is increasingly used for assessment of systolic and diastolic function in patients with metabolic cardiomyopathies. Objective: To assess the cardiac function in patients with pheochromocytoma using conventional and strain echocardiography.Design and method:
A prospective study was conducted in a single tertiary clinical centre. We investigated 24 consecutive patients (14 men and 10 women) with histologically verified pheochromocytomas. Clinical examination, 12-lead ECG and echocardiography (1D- and 2D-TTE; Color, Pulsed and Tissue Doppler; Speckle Tracking) were performed in all study participants at diagnosis of pheochromocytoma. Fourteen patients had follow-up visits 18.4 ± 10.4 months after surgery. Paired-samples T-test was used for comparison between pre- and post-operative means of the main echocardiographic parameters: left ventricular ejection fraction (EF), LV fractional shortening (FS), LV end-diastolic and systolic diameters (EDD, ESD), interventricular septal thickness (IVST), LV posterior wall thickness (PWT), deceleration time (DTE) and global longitudinal strain (GLS).Results:
Arterial pressure normalized in twelve of the patients (85.7%) after tumor removal. Hypertension in the rest two patients became well controlled under antihypertensive monotherapy. We did not find statistically relevant difference between pre- and post-operative EF (66.5 ± 7.6% vs. 67.6 ± 6.34%; p = 0.883) and ES (36.2 ± 6.8% vs. 35.9 ± 6.24%; p = 0.900). Global longitudinal strain was pathologically reduced in all patients at diagnosis of pheochromocytoma. We observed markedly decreased IVST (13.1 ± 1.49 mm vs. 11.6 ± 1.0 mm; p < 0.001), PWT (12.7 ± 1.26 mm vs. 11.7 ± 1.14 mm; p < 0.001) and DTE (206.4 ± 36.06 msec vs. 180.9 ± 15.13 msec; p = 0.032) corresponding to a significant improvement in GLS (−16.64 ± 1.49 vs. −19.57 ± 1.28; p < 0.001) after surgery in comparison with baseline.Conclusions:
Classical echocardiographic parameters usually used for assessment of cardiac function are not reliable tests in pheochromocytoma patients probably because of the hyperkinetic state. Instead, global longitudinal strain (GLS) seems to be a better predictor for the severity and the reversibility of catecholamine-induced myocardial damage in these subjects.