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Impact of disease activity on left ventricular performance in patients with acromegaly
Christian Bruch1, Burkhard Herrmann, Axel Schmermund
1Department of Cardiology, University Essen, Germany. bruchc@uni-muenster.de
Insights
Active acromegaly significantly impairs left ventricular (LV) diastolic function and overall performance. However, LV function appears normal in patients with cured or well-controlled acromegaly, indicating disease control is key.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Acromegaly, a condition caused by excess growth hormone, is associated with left ventricular (LV) abnormalities, including systolic and diastolic dysfunction, often linked to hypertension and LV hypertrophy.
- Previous studies suggest potential cardiac involvement in acromegaly, necessitating further investigation into the specific impact of disease activity on LV performance.
Purpose of the Study:
- To investigate the impact of active disease versus cured/well-controlled disease on left ventricular (LV) function in patients with acromegaly.
- To utilize advanced echocardiographic techniques, including tissue Doppler imaging (TDI), to assess systolic and diastolic LV performance.
Main Methods:
- A prospective study involving 15 patients with active acromegaly (AA), 18 patients with cured/well-controlled acromegaly (CA), and 24 healthy controls.
- Comprehensive 2D/Doppler echocardiography and tissue Doppler imaging (TDI) were performed to measure parameters of LV systolic and diastolic function, including mitral annular velocities and the Tei index.
- Key measurements included peak systolic velocity, early diastolic velocity (E'), late diastolic velocity (A'), E'/A' ratio, and the Tei index (isovolumic contraction/relaxation time divided by ejection time).
Main Results:
- Patients with active acromegaly (AA) exhibited significantly impaired diastolic function, evidenced by lower E' and E'/A' ratios compared to controls and CA groups.
- AA patients showed a reduced mitral peak velocity of early/late filling and prolonged deceleration time, indicating diastolic dysfunction.
- The Tei index, a measure of overall LV performance, was significantly elevated in the AA group compared to both control and CA groups, suggesting beginning impairment of overall LV function.
Conclusions:
- Active acromegaly significantly impacts left ventricular (LV) performance, particularly diastolic function.
- Patients with active acromegaly demonstrate diastolic dysfunction and early signs of impaired overall LV performance.
- In contrast, patients with cured or well-controlled acromegaly exhibit normal systolic and diastolic LV function, highlighting the importance of disease control.
Background:
In patients with acromegaly, abnormalities of systolic and diastolic left ventricular (LV) performance, mostly associated with hypertension or LV hypertrophy, have been reported. We used 2-dimensional/Doppler echocardiographic methods and tissue Doppler imaging (TDI) to elucidate the impact of disease activity on LV function in patients with acromegaly.
Methods:
In a prospective study design, 15 patients with active acromegaly (AA group; mean age-adjusted serum insuline-like growth factor-I [IGF-I] level, 420 +/- 170 ng/mL, mean growth hormone nadir during 75-g oral glucose load, 12.3 +/- 30.1 microg/L), 18 patients with cured (n = 14, mean IGF-I level 205 +/- 115 ng/mL, mean growth hormone nadir during glucose load 0.72 +/- 0.34 microg/L) or well-controlled (n = 4, normal age-adjusted ranges of IGF-I levels with medication with somatostatin analogues 354 +/- 88 ng/mL) acromegaly (CA group), and 24 control subjects (control group) underwent 2-dimensional/Doppler echocardiographic measurements, including assessment of the Tei index (isovolumic contraction time and isovolumic relaxation time divided by ejection time). Systolic and diastolic mitral annular velocities (peak systolic velocity, peak early diastolic velocity [E'], peak late diastolic velocity [A'], E'/A' ratio) were derived from pulsed TDI.
Results:
No significant differences between study groups were observed with respect to muscle mass and systolic parameters, such as ejection fraction, fractional shortening, and peak systolic velocity. In patients with AA, E' and the E'/A' ratio were lower than in control and CA subjects (AA 6.8 +/- 1.7 cm/s, control 10.0 +/- 1.7 cm/s, CA 9.1+/- 3.0 cm/s, P <.01 AA vs control, P <.05 AA versus CA, AA 0.68 +/- 0.22, control 0.98 +/- 0.16, CA 0.89 +/- 0.37, P <.01 AA vs control and CA, respectively). In comparison with control subjects and patients with CA, patients with AA had a reduced mitral peak velocity of early/late filling ratio (AA 0.78 +/- 0.22 m/s, control 1.12 +/- 0.33 m/s, CA 1.11 +/- 0.36 m/s, P <.05 AA vs control and CA) and a prolonged deceleration time (AA 223 +/- 41 ms, control 188 +/- 26 ms, CA 185 +/- 25 ms, P <.05 AA vs control and CA). The Tei index was significantly elevated in patients with AA in comparison with control subjects and patients with CA (AA 0.54 +/- 0.13, control 0.40 +/- 0.09, CA 0.44 +/- 0.10, P <.05 AA vs control and CA). No significant differences were observed between control subjects and patients with CA with respect to mitral flow-derived variables, TDI parameters, and the Tei index.
Conclusion:
Disease activity has a significant impact on LV performance in patients with acromegaly. In subjects with active disease, diastolic dysfunction and beginning impairment of overall LV performance are present. In patients with cured/well-controlled disease, systolic and diastolic function appear normal.