The role of N‐terminal pro‐brain natriuretic peptide, chromogranin A, and 5‐hydroxyindoleacetic acid in screening for carcinoid heart disease

Abstract

AbstractCarcinoid heart disease (CHD) is a serious complication for patients with neuroendocrine tumors (NETs), and early detection is crucial. We aimed to investigate N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), chromogranin A (CgA), and plasma 5‐hydroxyindoleacetic acid (P‐5‐HIAA) as a screening tool for detection of CHD. We prospectively included patients with disseminated small intestinal NETs (SI‐NETs) and performed transthoracic echocardiography (TTE), questionnaires, and biochemical assessment of NT‐proBNP, CgA, and P‐5‐HIAA. The presence and severity of CHD was assessed using a scoring system based on echocardiographic characteristics. A total of 93 patients were included in the final analysis. Fifteen (16%) were diagnosed with CHD. The median NT‐proBNP (219 ng/L vs. 124 ng/L, p = .05), CgA (3930 pmol/L vs. 256 pmoL/L, p < .0001), and P‐5‐HIAA (1160 nmol/L vs. 210 nmoL/L, p < .0001) were significantly higher in patients with CHD compared to non‐CHD patients. For NT‐proBNP, the area under the receiver operating characteristic (AUROC) curve for detection of CHD was 0.67 (95% CI: 0.50–0.84), and at a 260 ng/L cutoff level, the sensitivity and specificity were 46% and 79%. For CgA, the AUROC was 0.91 (95% CI: 0.84–0.97), and at a cutoff level of 598 pmol/L, the sensitivity and specificity were 100% and 69%. For P‐5‐HIAA, the AUROC was 0.89 (95% CI: 0.80–0.98), and at a cutoff level of 752 nmol/L, the sensitivity and specificity were 92% and 85%. In conclusion, CgA and P‐5‐HIAA proved excellent markers of CHD while NT‐proBNP lacked the required diagnostic accuracy to be used as a screening tool.