{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:56:57Z","timestamp":1785419817969,"version":"3.56.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Catecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations, including acute cardiac complications (ACCs) and subclinical myocardial injuries (SMIs). In this study, we aimed to conduct a comprehensive analysis of ACCs and SMIs in a large cohort of patients with PPGLs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2013 and July 2020 (n\u2009=\u2009189). The prevalence of ACCs and SMIs and characteristics of patients identified with ACCs and SMIs were investigated. Moreover, comparisons were performed between patients with and without ACCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fourteen patients (7.4%) fulfilled the criteria for ACCs, including nine (4.8%) who presented with Takotsubo-like cardiomyopathy, four (2.1%) with heart failure with preserved ejection fraction, and finally one (0.5%) with catecholamine-induced cardiomyopathy. Compared to those without ACCs (n\u2009=\u2009175), patients with ACCs had a higher prevalence of epinephrine-producing PPGLs (81.8% vs 33.9%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006) and were more likely to show invasive behavior (61.5% vs 27.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.022) or hemorrhage\/necrosis (53.9% vs 17.4%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005) on histology. The apical sparing pattern (5\/7, 71.4%) was the dominant impairment pattern of longitudinal strain (LS) for patients displaying Takotsubo-like cardiomyopathy. In patients without cardiac symptoms, a fairly high proportion (21\/77, 27.3%) of patients who underwent screening for troponin and\/or natriuretic peptide and\/or echocardiography had SMIs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>One in every fourteen PPGL patients presented with ACCs, and in the patients with Takotsubo-like cardiomyopathy, the apical sparing pattern was the primary impairment pattern of LS. Additionally, nearly one-third of patients without symptoms had SMIs. The diagnosis of PPGLs should be considered in patients with acute reversible cardiomyopathy, especially in those exhibiting an apical sparing pattern of LS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-021-02013-6","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T08:22:32Z","timestamp":1618993352000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Acute cardiac complications and subclinical myocardial injuries associated with pheochromocytoma and paraganglioma"],"prefix":"10.1186","volume":"21","author":[{"given":"Jing","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Xuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunxiang","family":"Miao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junting","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6565-8781","authenticated-orcid":false,"given":"Yunlang","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"issue":"8","key":"2013_CR1","doi-asserted-by":"publisher","first-page":"2435","DOI":"10.3390\/jcm9082435","volume":"9","author":"Y Shams","year":"2020","unstructured":"Shams Y, Falhammar H. Cardiovascular manifestations and complications of pheochromocytomas and paragangliomas. J Clin Med. 2020;9(8):2435.","journal-title":"J Clin Med"},{"issue":"9486","key":"2013_CR2","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/S0140-6736(05)67139-5","volume":"366","author":"JWM Lenders","year":"2005","unstructured":"Lenders JWM, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. The Lancet. 2005;366(9486):665\u201375.","journal-title":"The Lancet"},{"key":"2013_CR3","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.ijcard.2017.07.014","volume":"249","author":"R Zhang","year":"2017","unstructured":"Zhang R, Gupta D, Albert SG. Pheochromocytoma as a reversible cause of cardiomyopathy: analysis and review of the literature. Int J Cardiol. 2017;249:319\u201323.","journal-title":"Int J Cardiol"},{"issue":"10","key":"2013_CR4","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.4158\/EP171930.OR","volume":"23","author":"N Gagnon","year":"2017","unstructured":"Gagnon N, Mansour S, Bitton Y, Bourdeau I. Takotsubo-like cardiomyopathy in a large cohort of patients with pheochromocytoma and paraganglioma. Endocr Pract. 2017;23(10):1178\u201392.","journal-title":"Endocr Pract"},{"issue":"6","key":"2013_CR5","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1530\/EJE-15-0483","volume":"173","author":"A Riester","year":"2015","unstructured":"Riester A, Weismann D, Quinkler M, Lichtenauer UD, Sommerey S, Halbritter R, Penning R, Spitzweg C, Schopohl J, Beuschlein F, et al. Life-threatening events in patients with pheochromocytoma. Eur J Endocrinol. 2015;173(6):757\u201364.","journal-title":"Eur J Endocrinol"},{"issue":"19","key":"2013_CR6","first-page":"1438","volume":"99","author":"A Giavarini","year":"2013","unstructured":"Giavarini A, Chedid A, Bobrie G, Plouin PF, Hag\u00e8ge A, Amar L. Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma. Heart (British Cardiac Society). 2013;99(19):1438\u201344.","journal-title":"Heart (British Cardiac Society)"},{"issue":"5","key":"2013_CR7","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1055\/s-0032-1306294","volume":"44","author":"T Zelinka","year":"2012","unstructured":"Zelinka T, Petr\u00e1k O, Turkov\u00e1 H, Holaj R, Strauch B, Kr\u0161ek M, Vr\u00e1nkov\u00e1 AB, Musil Z, Du\u0161kov\u00e1 J, Kubinyi J, et al. High incidence of cardiovascular complications in pheochromocytoma. Hormone Metab Res. 2012;44(5):379\u201384.","journal-title":"Hormone Metab Res"},{"issue":"2","key":"2013_CR8","doi-asserted-by":"publisher","first-page":"76","DOI":"10.4250\/jcu.2011.19.2.76","volume":"19","author":"JH Park","year":"2011","unstructured":"Park JH, Kim KS, Sul JY, Shin SK, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW. Prevalence and patterns of left ventricular dysfunction in patients with pheochromocytoma. J Cardiovasc Ultrasound. 2011;19(2):76\u201382.","journal-title":"J Cardiovasc Ultrasound"},{"issue":"22","key":"2013_CR9","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.1093\/eurheartj\/ehy076","volume":"39","author":"JR Ghadri","year":"2018","unstructured":"Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W, et al. International expert consensus document on Takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018;39(22):2032\u201346.","journal-title":"Eur Heart J"},{"issue":"8","key":"2013_CR10","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1097\/HJH.0000000000002438","volume":"38","author":"JWM Lenders","year":"2020","unstructured":"Lenders JWM, Kerstens MN, Amar L, Prejbisz A, Robledo M, Taieb D, Pacak K, Crona J, Zelinka T, Mannelli M, et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020;38(8):1443\u201356.","journal-title":"J Hypertens"},{"issue":"9","key":"2013_CR11","doi-asserted-by":"publisher","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","volume":"150","author":"AS Levey","year":"2009","unstructured":"Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604\u201312.","journal-title":"Ann Intern Med"},{"issue":"5","key":"2013_CR12","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1210\/jc.2018-01707","volume":"104","author":"LM Gruber","year":"2019","unstructured":"Gruber LM, Hartman RP, Thompson GB, McKenzie TJ, Lyden ML, Dy BM, Young WF, Bancos I. Pheochromocytoma characteristics and behavior differ depending on method of discovery. J Clin Endocrinol Metab. 2019;104(5):1386\u201393.","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2013_CR13","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1530\/EC-17-0321","volume":"7","author":"H Falhammar","year":"2018","unstructured":"Falhammar H, Kjellman M, Calissendorff J. Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect. 2018;7(1):186\u201392.","journal-title":"Endocr Connect"},{"issue":"7","key":"2013_CR14","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1055\/s-0032-1311634","volume":"44","author":"A Porzig","year":"2012","unstructured":"Porzig A, Matthay KK, Dubois S, Pampaloni M, Damon L, Hawkins R, Goldsby R, Hollinger F, Fitzgerald P. Proteinuria in metastatic pheochromocytoma is associated with an increased risk of Acute Respiratory Distress Syndrome, spontaneously or after therapy with 131I-meta-iodobenzylguanidine (131I-MIBG). Hormone Metab Res. 2012;44(7):539\u201342.","journal-title":"Hormone Metab Res"},{"issue":"6","key":"2013_CR15","doi-asserted-by":"publisher","first-page":"690","DOI":"10.4158\/EP161718.RA","volume":"23","author":"G Gupta","year":"2017","unstructured":"Gupta G, Pacak K. Precision medicine: an update on genotype\/biochemical phenotype relationships in pheochromocytoma\/paraganglioma patients. Endocr Pract. 2017;23(6):690\u2013704.","journal-title":"Endocr Pract"},{"issue":"5","key":"2013_CR16","doi-asserted-by":"publisher","first-page":"E1223","DOI":"10.1152\/ajpendo.90591.2008","volume":"295","author":"G Eisenhofer","year":"2008","unstructured":"Eisenhofer G, Huynh TT, Elkahloun A, Morris JC, Bratslavsky G, Linehan WM, Zhuang Z, Balgley BM, Lee CS, Mannelli M, et al. Differential expression of the regulated catecholamine secretory pathway in different hereditary forms of pheochromocytoma. Am J Physiol Endocrinol Metab. 2008;295(5):E1223-1233.","journal-title":"Am J Physiol Endocrinol Metab"},{"issue":"11","key":"2013_CR17","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1097\/HJH.0b013e32834a4ce9","volume":"29","author":"A Prejbisz","year":"2011","unstructured":"Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A. Cardiovascular manifestations of phaeochromocytoma. J Hypertens. 2011;29(11):2049\u201360.","journal-title":"J Hypertens"},{"issue":"1","key":"2013_CR18","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/his.13402","volume":"72","author":"J Turchini","year":"2018","unstructured":"Turchini J, Cheung VKY, Tischler AS, De Krijger RR, Gill AJ. Pathology and genetics of phaeochromocytoma and paraganglioma. Histopathology. 2018;72(1):97\u2013105.","journal-title":"Histopathology"},{"issue":"11","key":"2013_CR19","doi-asserted-by":"publisher","first-page":"1836","DOI":"10.1016\/j.amjcard.2016.03.019","volume":"117","author":"S Yh","year":"2016","unstructured":"Yh S. Clinical features and outcome of pheochromocytoma-induced takotsubo syndrome: analysis of 80 published cases. Am J Cardiol. 2016;117(11):1836\u201344.","journal-title":"Am J Cardiol"},{"issue":"23","key":"2013_CR20","doi-asserted-by":"publisher","first-page":"460","DOI":"10.21037\/atm.2018.11.08","volume":"6","author":"HH Awad","year":"2018","unstructured":"Awad HH, McNeal AR, Goyal H. Reverse Takotsubo cardiomyopathy: a comprehensive review. Ann Transl Med. 2018;6(23):460.","journal-title":"Ann Transl Med"},{"issue":"6","key":"2013_CR21","first-page":"464","volume":"59","author":"YL Dai","year":"2020","unstructured":"Dai YL, Zhou J, Lin J, Hu JT, Zhao X. Recurrent Takotsubo syndrome associated with pheochromocytoma: a case report. Zhonghua Nei Ke Za Zhi. 2020;59(6):464\u20137.","journal-title":"Zhonghua Nei Ke Za Zhi"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-02013-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-021-02013-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-02013-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T08:38:03Z","timestamp":1618994283000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-021-02013-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,21]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2013"],"URL":"https:\/\/doi.org\/10.1186\/s12872-021-02013-6","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-134946\/v1","asserted-by":"object"}]},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,21]]},"assertion":[{"value":"11 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Institutional Review Board (IRB) of Soochow University. All patient records were anonymized before analysis and the requirement for informed consent was waived by the IRB of Soochow University due to the retrospective nature of the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The author declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"203"}}