Coronary Imaging

1350711 - Elevated Catecholamine Levels Lead to Coronary Arterial Vasoconstriction in Pheochromocytoma and Paraganglioma Patients

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

LB

Leilah N. Baumgarten, BSc

Fellow
National Institute of Diabetes and Digestive and Kidney Diseases, Maryland, United States

Primary Author(s)

LB

Leilah N. Baumgarten, BSc

Fellow
National Institute of Diabetes and Digestive and Kidney Diseases, Maryland, United States

Co-Author(s)

MN

Mathew A. Nazari, MD

Research Fellow
National Institutes of Health, Maryland, United States
JA

Jha Abhishek, MD

Fellow
National Institutes of Health, Maryland, United States
RJ

Raj Jatin Matta, PhD

Researcher/ Associate Investigator
National Institute of Diabetes and Digestive and Kidney Diseases, Maryland, United States
ST

Sara Talvacchio, RN

Clinical Research Nurse
National Institutes of Health, Maryland, United States
KC

Kailah Charles, BSc

Fellow
National Institutes of Health, Maryland, United States
JF

Jenna Feeley, BSc

Fellow
National Institute of Diabetes and Digestive and Kidney Diseases, Maryland, United States
MP

Mayank Patel, MD

Special Researcher
National Institutes of Health, Maryland, United States
RF

Richard Feelders, MD, PhD

Researcher/ Visiting Professor
National Institutes of Health, Netherlands
KP

Karel Pacak, MD, PhD

Principal Investigator
National Institutes of Health, Maryland, United States
AG

Ahmed M. Gharib, MD

Senior Investigator
National Institute of Diabetes and Digestive and Kidney Diseases, Maryland, United States
KA

Khaled Z. Abd-Elmoniem, PhD

Staff Scientist
National Institute of Diabetes and Digestive and Kidney Diseases, Maryland, United States

Background: Pheochromocytoma and paragangliomas (PPGL) are neuroendocrine tumors that produce and secrete catecholamines. PPGL patients have increased prevalence of cardiovascular disease.¹ Many PPGL patients endure myocardial stress due to high levels of catecholamines that cause hypertension, hyperglycemia, and hyperlipidemia.They have increased risk of myocardial damage due to alpha-adrenoceptor mediated coronary and microvascular vasoconstriction. No other studies have documented the effect of PPGL on the coronary arteries in humans. Hence, the aim of this study is to investigate how catecholamines influence coronary artery atherosclerosis and luminal area in PPGL patients versus healthy controls (HC) using MRI and CT imaging.

Methods: A total of 32 subjects participated in this prospective study after signing informed consent; 16 PPGL’s and 16 HC’s. Coronary wall thickness (VWT) and lumen area (VLA) imaging was obtained using free-breathing time-resolved dark-blood (TRAPD) of the proximal right coronary artery acquired with a fixed inversion time (TI = 200 ms) and phase-sensitive reconstruction². Images were anonymized, VWT and VLA were measured as previously published². To assess for coronary atherosclerotic disease (CAD) plaque burden, coronary computed tomographic (CT) angiography-derived CAD scores were obtained through measuring the calcium score, segment involvement score (SIS), stenosis score (SSS), and volume score (SVS) in all participants as in prior studies.²

Results: MRI VWT of the proximal right coronary artery in both groups were similar (PPGL 1.2 ± 0.1 mm, HC 1.2 ± 0.1 mm, p-value=0.245). This indicates that there is no increase in subclinical atherosclerotic burden, however, the PPGL patients had a statistically significant reduction in VLA of approximately 55% compared to the healthy group (PPGL 3.6 ± 1.9 mm², HC 7.9 ± 6.1 mm², p=value=0.028). CT images of the entire coronary tree also confirmed the absence of significant difference in atherosclerotic plaque burden between both subject groups with similar variables of calcium score, SIS, SVS, and SSS (Table).

Conclusion: This study investigates how catecholamines influence coronary artery atherosclerosis, vessel wall thickness, and luminal area. The results show that elevated catecholamines in PPGL patients reduced the coronary VLA despite the use of alpha-adrenoceptor blockers. In addition, neither atherosclerosis nor VWT were different between both subject groups despite the metabolic effects induced by catecholamines.The main distinction was the reduction of coronary VLA in PPGL patients compared to HC (Figure). This may explain the increased risk of myocardial damage in these patients with PPGL and suggests vasoconstrictions as a potential etiology rather than increase in coronary atherosclerotic burden. This may help guide preventative management in PPGL patients towards better mitigation of cardiovascular morbidly and mortality.