Abstract
Background: 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). Hence, we aimed to conduct a comprehensive analysis of ACCs and SMIs in a large cohort of PPGLs.Methods: We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2013 and July 2020 (n = 189). The prevalence and presentation of ACCs and SMIs were investigated, and comparisons were conducted between cases with and without ACCs. Results: Fourteen patients (7.4%) fulfilled the criteria for ACCs, consisting of nine cases (4.8%) with Takotsubo-like cardiomyopathy, three cases (1.6%) with heart failure with preserved ejection fraction, and the remaining one (0.5%) with catecholamine-induced cardiomyopathy. Compared to those without ACCs (n = 175), patients with ACCs had higher prevalence of epinephrine-producing PPGLs (81.8% vs 33.9%. P = 0.006), and were more likely to show invasive behavior (61.5% vs 27.3%, P = 0.022) and hemorrhage/necrosis (53.9% vs 17.4%, P = 0.005) at histology. Among patients suffered Takotsubo-like cardiomyopathy, an apical sparing pattern (5/7, 71.4%) dominated in the impaired patterns of longitudinal strain (LS). In the end, a fairly high percent (21/77, 27.2%) of patients (excluding 14 cases with ACCs) who underwent screening troponin, natriuretic peptide, and echocardiography had SMIs.Conclusions: One in every fourteen PPGLs patients presented with ACCs; and, in the cases with Takotsubo-like cardiomyopathy, an apical sparing pattern was the primary pattern in LS. Furthermore, nearly one-third of patients without symptoms had SMIs. The diagnosis of PPGLs should be considered in patients with acute reversible cardiomyopathy, especially with an apical sparing pattern in LS.