D-43 | The Prognostic Value of Invasive Hemodynamic Monitoring in Patients With Carcinoid Heart Disease Needing Bioprosthetic Valve Replacement

Abstract

Carcinoid heart disease (CnHD) is a serious cause of morbidity and mortality in patients with carcinoid neuroendocrine tumors. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the utility of invasive hemodynamic evaluation prior to valvular intervention to predict survivorship. We conducted the first known prospective study of CnHD survival by right heart catheterization (RHC) waveform morphology. 50 patients with symptomatic CnHD met inclusion criteria: having RHC within 3 months prior to bioprosthetic valve replacement. They were categorized into 3 morphologic waveform groups: “Preserved A, V wave,” “tall V wave,” and “ventricularized RV wave.” The 3 groups were evaluated for all-cause mortality. Median follow-up was 29 months and median overall survival was 26 months. Compared to the preserved A&V waveform group, ventricularized RV waveform carried a hazard of death ratio by over four-fold in multivariate Cox regression (HR 4.54, 95%CI 1.03-19.96, p=0.046). Median survival was significantly reduced for ventricularized RV compared to A&V (p=0.046), though there was no significant difference for tall V waveform patients (p=0.724). Our data show that a ventricularized RV waveform on RHC is a significant and independent mortality predictor for CnHD. This may provide unique longitudinal evidence that RHC may be a particularly helpful risk stratification tool for symptomatic CnHD patients needing bioprosthetic valve replacement.