Key result
PFO is linked to rare left-sided valve involvement in carcinoid heart disease.
Why the study?
Carcinoid heart disease rarely affects left-sided valves in the setting of patent foramen ovale, but the impact of PFO on valve disease progression and prognosis is not well understood.
Does the presence of a patent foramen ovale increase the progression of left-sided valve disease in patients with carcinoid syndrome?
Cohort (n=175)
Does the presence of a patent foramen ovale increase the progression of left-sided valve disease in patients with carcinoid syndrome?
In patients with carcinoid syndrome, the presence of a patent foramen ovale is associated with an increased risk of left-sided valve disease progression, left-sided valve surgery, and stroke.
PFO status should not alter management of carcinoid heart disease; leaves open its effect on valve progression and prognosis.
BACKGROUND: Carcinoid heart disease (CaHD) typically affects the right-sided valves. Rarely, CaHD affecting the left-sided valves has been observed in the setting of patent foramen ovale (PFO). However, the impact of PFO on valve disease progression and prognosis in CaHD is not well understood. OBJECTIVES: The purpose of this study was to evaluate the impact of PFO on CaHD progression and clinical outcomes. METHODS: Patients diagnosed with neuroendocrine tumor and carcinoid syndrome (CS), and with serial transthoracic echocardiograms, were included. The primary endpoint was progression of left-sided valve disease. Secondary endpoints included the requirement for left-sided cardiac valve surgery, progression of right-sided valve disease, mortality, and stroke. RESULTS: Of 413 patients with neuroendocrine tumor and CS, 175 met the inclusion criteria; mean age 61.3 ± 11.3 years, 54.9% male, and 67 patients had a PFO. Through 3.6 years (1.1-5.9) between serial transthoracic echocardiograms, patients with PFO were more likely to have progression of left-sided valve disease (adjusted HR [aHR]: 1.93; 95% CI: 1.09-3.42; P = 0.025) and require left-sided valve replacement (13.6% vs 2.1%, log-rank; P = 0.012). Patients with PFO did not have a significant increase in right-sided progression (aHR: 1.51; 95% CI: 0.91-2.51; P = 0.111). Patients with a PFO also had an increased risk of stroke (aHR: 5.42; 95% CI: 1.57-18.70; P = 0.007). CONCLUSIONS: Patients with CS and PFO were at increased risk of progression of left-sided valve disease and valve surgery. PFO presence was also associated with an increased risk of stroke, highlighting the importance of surveillance and consideration of potential early intervention.
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Scalia et al. (2026) conducted a cohort in Carcinoid heart disease (n=175). Patent foramen ovale (PFO) vs. No PFO was evaluated on Progression of left-sided valve disease (aHR 1.93, 95% CI 1.09-3.42, p=0.025). The presence of a patent foramen ovale in patients with carcinoid syndrome was associated with an increased risk of left-sided valve disease progression (aHR 1.93; 95% CI 1.09-3.42; P=0.025).
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