J Cardiovasc Ultrasound.  2011 Jun;19(2):76-82. 10.4250/jcu.2011.19.2.76.

Prevalence and Patterns of Left Ventricular Dysfunction in Patients with Pheochromocytoma

• Park JH
• Kim KS
• Sul JY
• Shin SK
• Kim JH
• Lee JH
• Choi SW
• Jeong JO
• Seong IW

• KMID: 1980355
• DOI: http://doi.org/10.4250/jcu.2011.19.2.76

Abstract

BACKGROUND
Excessive catecholamine release in pheochromocytoma is known to cause transient reversible left ventricular (LV) dysfunction, such as in the case of pheochromocytoma-associated catecholamine cardiomyopathy. We investigated patterns of clinical presentation and incidence of LV dysfunction in patients with pheochromocytoma.
METHODS
From January 2004 to April 2011, consecutive patients with pheochromocytoma were retrospectively studied with clinical symptoms, serum catecholamine profiles, and radiologic findings. Patterns of electrocardiography and echocardiography were also analyzed.
RESULTS
During the study period, a total of 36 patients (21 males, 49.8 +/- 15.8 years, range 14-81 years) with pheochromocytoma were included. In the electrocardiographic examinations, normal findings were the most common findings (19, 52.8%). LV hypertrophy in 12 cases (33.3%), sinus tachycardia in 3 (8.3%), ischemic pattern in 1 (2.8%) and supraventricular tachycardia in 1 (2.8%). Echocardiographic exam was done in 29 patients (80.6%). Eighteen patients (62.1%) showed normal finding, 8 (27.6%) revealed concentric LV hypertrophy with normal LV systolic function, and 3 (10.3%) demonstrate LV systolic dysfunction (LV ejection fraction < 50%). Three showed transient LV dysfunction (2 with inverted Takotsubo-type cardiomyopathy and 1 with a diffuse hypokinesia pattern). Common presenting symptoms in the 3 cases were new onset chest discomfort and dyspnea which were not common in the other patients. Their echocardiographic abnormalities were normalized with conventional treatment within 3 days.
CONCLUSION
Out of total 36 patients with pheochromocytoma, 3 showed transient LV systolic dysfunction (catecholamine cardiomyopathy). Pheochromocytoma should be included as one of possible causes of transient LV systolic dysfunction.

Keyword

Pheochromocytoma; Catecholamine cardiomyopathy; Echocardiography

MeSH Terms

Cardiomyopathies
Dyspnea
Echocardiography
Electrocardiography
Humans
Hypertrophy
Hypokinesia
Incidence
Male
Pheochromocytoma
Prevalence
Retrospective Studies
Tachycardia, Sinus
Tachycardia, Supraventricular
Thorax
Ventricular Dysfunction, Left

Figure

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  Fig. 1 An apical four-chamber view of the left ventricle in the emergency department is shown at end-diastole (A) and end-systole (B). At end-systole, mid- and basal ventricular ballooning was noted. The follow-up echocardiographic study was performed after three days of treatment. The left ventricular dimension was decreased and ballooning had disappeared (C at end-diastole and D at end-systole).

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  Fig. 2 Chest radiography shows pulmonary edema which improved after 3 days of treatment. A: On admission. B: After treatment.

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  Fig. 3 An apical four-chamber view of the left ventricle in the emergency department is shown at end-diastole (A) and end-systole (B). Apical wall motion is normal. However, mid- and basal ventricular ballooning is noted. The follow-up echocardiographic study performed after three days of treatment demonstrates decreased left ventricular size and disappeared mid- and basal ventricular ballooning (C at end-diastole and D at end-systole).

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  Fig. 4 Chest radiography demonstrates marked pulmonary edema which normalized after 3 days of treatment. A: On admission. B: After treatment.

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