{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:32:07Z","timestamp":1783074727956,"version":"3.54.6"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2019,3,23]],"date-time":"2019-03-23T00:00:00Z","timestamp":1553299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The background to this study was that factors associated with carcinoid heart disease (CHD) and its impacts on overall survival (OS) are scantly investigated in patients (pts) with neuroendocrine tumors (NETs). In terms of materials and methods, a retrospective multicenter cohort study was conducted of factors associated with CHD in advanced NET pts with carcinoid syndrome (CS) and\/or elevated urinary 5-hidroxyindole acetic acid (u5HIAA). CHD was defined as at least moderate right valve alterations. The results were the following: Among the 139 subjects included, the majority had a midgut NET (54.2%), 81.3% had CS, and 93% received somatostatin analogues. In a median follow-up of 39 months, 48 (34.5%) pts developed CHD, with a higher frequency in pts treated in public (77.2%) versus private settings (22.9%). In a multivariate logistic regression, unknown primary or colorectal NETs (Odds Ratio (OR) 4.35; p = 0.002), at least 50% liver involvement (OR 3.45; p = 0.005), and being treated in public settings (OR 4.76; p = 0.001) were associated with CHD. In a Cox multivariate regression, bone metastases (Hazard Ratio {HR} 2.8; p = 0.031), CHD (HR 2.63; p = 0.038), and a resection of the primary tumor (HR 0.33; p = 0.026) influenced the risk of death. The conclusions were the following: The incidence of CHD was higher in pts with a high hepatic tumor burden and in those treated in a public system. Delayed diagnosis and limited access to effective therapies negatively affected the lives of NET patients.<\/jats:p>","DOI":"10.3390\/jcm8030405","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T06:56:52Z","timestamp":1553497012000},"page":"405","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Carcinoid Heart Disease and Decreased Overall Survival among Patients with Neuroendocrine Tumors: A Retrospective Multicenter Latin American Cohort Study"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6883-6678","authenticated-orcid":false,"given":"Deise","family":"Uema","sequence":"first","affiliation":[{"name":"Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1920-142X","authenticated-orcid":false,"given":"Carolina","family":"Alves","sequence":"additional","affiliation":[{"name":"Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Eduardo","family":"Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil"},{"name":"Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Siepmann","sequence":"additional","affiliation":[{"name":"Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Angel","sequence":"additional","affiliation":[{"name":"Instituto Alexander Fleming, C1426ANZ Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana F. M.","family":"Rego","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Onofre Lopes, Natal 59012-300, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Weschenfelder","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento, Porto Alegre 90035-001, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duilio R.","family":"Rocha Filho","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Walter Cant\u00eddio, Fortaleza 60430-372, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederico P.","family":"Costa","sequence":"additional","affiliation":[{"name":"Hospital Sirio Liban\u00eas, S\u00e3o Paulo 01308-050, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton","family":"Barros","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6975-5466","authenticated-orcid":false,"given":"Juan M.","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Hospital de Gastroenterolog\u00eda Bonorino Udaondo, C1264AAA Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben M.","family":"Illigens","sequence":"additional","affiliation":[{"name":"Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany"},{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel P.","family":"Riechelmann","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"647","DOI":"10.2217\/fca.10.87","article-title":"Surgery for carcinoid heart disease: Current outcomes, concerns and controversies","volume":"6","author":"Raja","year":"2010","journal-title":"Future Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00000658-198207000-00008","article-title":"Carcinoid Syndrome from Gastrointestinal Carcinoids without Liver Metastasis","volume":"196","author":"Feldman","year":"1982","journal-title":"Ann Surg"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/mpo.2950200307","article-title":"Carcinoid Syndrome in the Absence of Liver Metastasis: A Case Report and Review of Literature","volume":"20","author":"Haq","year":"1992","journal-title":"Med. 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