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Acromegaly: evidence for a direct relation between disease activity and cardiac dysfunction in patients without
Burkhard L Herrmann1, C Bruch, B Saller
1Department of Internal Medicine, Division of Endocrinology, University of Essen, Hufelandstrasse 55, D-45122 Essen, Germany. burkhard.hermann@uni-essen.de
Insights
Active acromegaly impairs diastolic function in patients with normal left ventricular mass. Tissue Doppler imaging and the Tei-Index can detect this dysfunction, which is linked to disease activity.
Area of Science:
- Cardiology
- Endocrinology
- Echocardiography
Background:
- Acromegaly frequently causes cardiac abnormalities, including left ventricular (LV) hypertrophy and heart failure.
- Previous studies noted systolic and diastolic dysfunction in acromegaly, often linked to LV hypertrophy.
- The effect of active acromegaly on LV performance in patients with normal or mildly increased LV mass was not well-defined.
Purpose of the Study:
- To investigate the impact of active acromegaly on left ventricular (LV) performance.
- To assess diastolic function in patients with active acromegaly and normal or slightly elevated LV mass.
- To evaluate the utility of tissue Doppler imaging (TDI) and the myocardial performance index (Tei-Index) in detecting cardiac dysfunction in acromegaly.
Main Methods:
- Conventional 2D/Doppler echocardiography and TDI of the mitral annulus were used.
- 13 patients with active acromegaly (AA), 19 cured/controlled patients (CA), and 21 healthy controls (CON) were studied.
- The combined myocardial performance index (Tei-Index) was calculated for all participants.
Main Results:
- Early diastolic annular velocity (ET) and the ET/AT ratio were significantly reduced in the AA group compared to CA and CON.
- Patients with active acromegaly showed a prolonged deceleration time.
- The Tei-Index was significantly higher in the AA group than in controls, indicating impaired myocardial performance.
Conclusions:
- Diastolic dysfunction is detectable by TDI in active acromegaly patients with normal or mildly increased LV mass.
- This diastolic dysfunction appears directly related to acromegaly disease activity.
- The Tei-Index is a sensitive tool for assessing both systolic and diastolic LV function in acromegalic patients.
Background And Aims:
Cardiac abnormalities, such as cardiomegaly and congestive heart failure, occur frequently in advanced acromegaly. Abnormalities of systolic and diastolic function, mostly associated with left ventricular (LV) hypertrophy, have been reported. The impact of disease activity on LV performance in patients with normal or slightly elevated LV muscle mass has not been demonstrated.
Patients And Methods:
Conventional two-dimensional/Doppler echocardiography and tissue Doppler imaging (TDI) of the mitral annulus were performed in 13 patients with active acromegaly (AA) and normal or slightly elevated LV muscle mass (< 140 g/m2) and in 19 cured/well-controlled patients (CA). A group of 21 volunteers without symptoms or signs of cardiac disease served as controls (CON). The combined myocardial performance index (Tei-Index) was determined in all patients and controls.
Results:
Muscle mass index of the left ventricle, ejection fraction, fractional shorting, E/ET-ratio, systolic (ST) and late diastolic (AT) annular velocities did not differ significantly between the three groups. In the AA group, the early diastolic annular velocity ET[7.13 +/- 2.11 (AA); 9.83 +/- 3.29 (CA); 10.10 +/- 1.70 m/s (CON); P < 0.05 AA vs. CA, P < 0.005 AA vs. CON] and the ET/AT-ratio [0.71 +/- 0.26 (AA); 0.95 +/- 0.33 (CA); 1.00 +/- 0.15 m/s (CON); P < 0.05 AA vs. CA, P < 0.005 AA vs. CON] were significantly reduced. Patients with AA had a longer deceleration time [209 +/- 19 (AA); 179 +/- 22 (CA); 185 +/- 26 ms (CON); P < 0.05]. The Tei-Index was significantly higher in AA in comparison with CON [0.50 +/- 0.15 (AA); 0.48 +/- 0.12 (CA); 0.41 +/- 0.10 (CON); P < 0.05 AA vs. CON]. Subjects with CA did not differ significantly from controls with respect to 2-D/Doppler echo- and TDI-derived parameters.
Conclusion:
The data demonstrate that diastolic dysfunction can be verified by tissue Doppler imaging in patients with active acromegaly with normal or slightly elevated muscle mass of the left ventricle and seems to be related to disease activity. The Tei-Index as a sensitive combined myocardial performance index can be used to complete the assessment of systolic and diastolic LV performance in acromegalic patients.