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Cardiovascular complications in acromegaly: methods of assessment
G Vitale1, R Pivonello, M Galderisi
1Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
Insights
Acromegaly commonly affects the heart, causing hypertrophy and diastolic dysfunction. Advanced imaging like Pulsed Tissue Doppler and radionuclide angiography are crucial for assessing cardiac function and morphology in these patients.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Cardiac involvement is a frequent complication of acromegaly.
- Common manifestations include cardiac hypertrophy, dilation, and diastolic filling abnormalities.
Purpose of the Study:
- To review the cardiac implications of acromegaly.
- To highlight advanced diagnostic techniques for cardiac assessment in acromegaly patients.
Main Methods:
- Echocardiography for ventricular hypertrophy and function.
- Pulsed Tissue Doppler for myocardial motion analysis.
- Radionuclide angiography for systolic and diastolic function assessment.
- Coronary angiography and perfusional scintigraphy for coronary artery disease.
- Doppler analysis of carotid arteries for atherosclerosis.
Main Results:
- Echocardiography reveals ventricular hypertrophy; advanced ultrasound techniques offer detailed myocardial assessment.
- Radionuclide angiography provides operator-independent evaluation of cardiac performance.
- Coronary artery disease is less studied but may improve with treatment.
- Endothelial dysfunction is more prevalent than atherosclerosis in active acromegaly.
Conclusions:
- Comprehensive assessment of cardiac function, morphology, and activity is essential for managing acromegaly.
- Advanced imaging modalities improve diagnostic accuracy and patient management.
Abstract:
Cardiac involvement is common in acromegaly. Evidence for cardiac hypertrophy, dilation and diastolic filling abnormalities has been widely reported in literature. Generally, ventricular hypertrophy is revealed by echocardiography but early data referred increased cardiac size by standard X-ray. Besides, echocardiography investigates cardiac function and value disease. There are new technologic advances in ultrasonic imaging. Pulsed Tissue Doppler is a new non-invasive ultrasound tool which extends Doppler applications beyond the analysis of intra-cardiac flow velocities until the quantitative assessment of the regional myocardial left ventricular wall motion, measuring directly velocities and time intervals of myocardium. The radionuclide techniques permit to study better the cardiac performance. In fact, diastolic as well as systolic function can be assessed at rest and at peak exercise by equilibrium radionuclide angiography. This method has a main advantage of providing direct evaluation of ventricular function, being operator independent. Coronary artery disease has been poorly studied mainly because of the necessity to perform invasive procedures. Only a few cases have been reported with heart failure study by coronarography and having alterations of perfusion which ameliorated after somatostatin analog treatment. More recently, a few data have been presented using perfusional scintigraphy in acromegaly, even if coronary artery disease does not seem very frequent in acromegaly. Doppler analysis of carotid arteries can be also performed to investigate atherosclerosis: however, patients with active acromegaly have endothelial dysfunction more than clear-cut atherosclerotic plaques. In conclusion, careful assessments of cardiac function, morphology and activity need in patients with acromegaly.