Korean Circ J.  2014 Mar;44(2):89-96. 10.4070/kcj.2014.44.2.89.

Impact of Pheochromocytoma on Left Ventricular Hypertrophy and QTc Prolongation: Comparison with Takotsubo Cardiomyopathy

• Choi SY
• Cho KI
• Han YJ
• You GI
• Kim JH
• Heo JH
• Kim HS
• Cha TJ
• Lee JW

• KMID: 2223897
• DOI: http://doi.org/10.4070/kcj.2014.44.2.89

Abstract

BACKGROUND AND OBJECTIVES
Excessive catecholamine causes the alteration of cardiac structure and function. This study evaluated if there is any difference in left ventricular hypertrophy (LVH) and QTc prolongation in conditions with pheochromocytoma and Takotsubo cardiomyopathy (TC).
SUBJECTS AND METHODS
We reviewed the medical records of 20 pheochromocytoma patients for cardiovascular events prior to diagnosis. The patient's clinical history and electrocardiographic and echocardiographic findings were compared to those of 20 patients diagnosed with TC.
RESULTS
Left ventricular (LV) mass index (133.3+/-37.8 vs. 113.3+/-17.3, p=0.031), relative wall thickness (0.55+/-0.15 vs. 0.47+/-0.07, p=032) and elevated blood pressure (BP) were more prominent in pheochromocytoma compared to TC. The mean creatinine kinase-MB elevation, reduced LV systolic function and ST segment changes were more prominent in the TC group compared to the pheochromocytoma groups (all p<0.05). The prevalence of QTc prolongation was high in patients with pheochromocytoma (45%) and TC (55%), and TC male patients appeared to have a more prolonged QTc interval. Urine epinephrine (r=0.844, p=0.004) and norepinephrine level (r=0.782, p=0.013) were significantly correlated with LV mass index, and the predictors for the QTc prolongation were male gender and the presence of LVH.
CONCLUSION
A prolonged QTc was prominent in pheochromocytoma and TC regardless of BP and systolic LV function, and LVH was more prominent in pheochromocytoma than TC.

Keyword

Long QT syndrome; Hypertrophy, left ventricular; Catecholamines

MeSH Terms

Blood Pressure
Catecholamines
Diagnosis
Echocardiography
Electrocardiography
Epinephrine
Humans
Hypertrophy, Left Ventricular*
Long QT Syndrome
Male
Medical Records
Norepinephrine
Pheochromocytoma*
Prevalence
Takotsubo Cardiomyopathy*
Catecholamines
Epinephrine
Norepinephrine

Figure

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  Fig. 1 Electrocardiography (ECG) of a patient with prominent QTc prolongation. The patient complained of intermittent palpitation and diaphoresis with syncope for 4 years. A: her ECG on admission showed normal sinus rhythm with a prolonged QTc interval (596 msec). B: two days after admission, a sudden onset of chest pain and syncope with loss of consciousness occurred abruptly, and ECG monitoring indicated torsades de pointes. C: after right adrenal gland removal, her electrocardiography returned to normal.

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