INTERVENTIONAL THERAPIES IN CARCINOID HEART DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Main Article Content
Keywords
Carcinoid heart disease, Interventional therapies, Neuroendocrine tumors
Abstract
Carcinoid heart disease is a rarely occurring cardiac manifestation that typically affects the right-sided heart valves and ultimately results in right heart failure, and it occurs in patients with advanced neuroendocrine tumors and the carcinoid syndrome. Online databases such as Midline, Google Scholar, and the PubMed databases, were searched using the following methodology to find papers regarding the therapies of carcinoid heart disease. Relevant publications were evaluated for study quality and evaluate by independent reviewers. Treatment type was taken into account when stratifying the meta-analysis of the intervention's effects on symptoms connected to carcinoid heart disease. 3682 treatment interventions on outcomes unique to carcinoid heart disease were gathered from 93 research, according to our results. The study's overall quality was poor because it included just six randomized controlled clinical studies. Octreotide and lanreotide, two somatostatin analogs, improved symptoms in 65–72% of patients and caused a biochemical response in 45–46% of them. In 72–84% of cases, flushes and/or diarrhea were reduced as a result of an increase in dosage, frequency, or interclass transition. In 82% of carcinoid heart disease patients with a liver-dominant disease, liver-directed therapy can alleviate symptoms, according to a retrospective institutional series. 40 percent of patients with diarrhea resistant to somatostatin analogs experienced a reduction in bowel movements after taking the serotonin synthesis inhibitor telotristat ethyl. In 45–63% of instances, interferon-alpha was able to control the carcinoid heart disease symptoms. After radionuclide therapy, favorable response has been shown in subgroup analyses of studies that do not explicitly involve patients with carcinoid heart disease. In the carcinoid heart disease, chemotherapy and everolimus did not provide a noticeable effect. We conclude that patients with carcinoid heart disease can get numerous courses of treatment. It is highly recommended to start randomized controlled studies using carcinoid heart disease symptoms as the primary outcome.
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Shakirat Ganiyu
University of Texas Rio Grande Valley Knapp Medical Center, Weslaco, Texas
Umar Khatab
Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University, Islamabad, Pakistan.
Manzoor Ullah
Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University, Islamabad, Pakistan.
Zobia Aslam
Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University, Islamabad, Pakistan.
Mehar Masood
Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University, Islamabad, Pakistan.
Kaleem Ahmad
Faculty of Rehabilitation and Allied Health Sciences (FRAHS), Riphah International University, Islamabad, Pakistan.