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Cardiac hypertrophy and function in asymptomatic acromegaly
D Morvan1, M Komajda, A Grimaldi
1Service de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
Insights
Subclinical heart abnormalities are common in acromegaly patients without obvious heart disease. Echocardiography revealed increased cardiac mass and diastolic dysfunction, particularly in hypertensive acromegalic individuals.
Area of Science:
- Cardiology
- Endocrinology
Background:
- Acromegaly, a condition caused by excess growth hormone, is linked to heart disease.
- Investigating cardiac changes in asymptomatic acromegaly is crucial for early detection.
Purpose of the Study:
- To assess cardiac mass and function in asymptomatic acromegaly patients using Doppler echocardiography.
- To compare cardiac parameters between acromegalic patients and healthy controls.
Main Methods:
- Doppler echocardiography was performed on 15 asymptomatic acromegalic patients (including 6 with hypertension) and 10 age-matched controls.
- Key measurements included left ventricular mass index (LVMI), shortening fraction, systolic time intervals, mitral EF slope, and isovolumic relaxation period (IRP).
Main Results:
- Acromegalic patients showed increased LVMI (110 vs 32 g m-2) compared to controls.
- Diastolic dysfunction was indicated by a decreased mitral EF slope and prolonged IRP in acromegalic patients.
- Hypertensive acromegalic patients had significantly higher LVMI than normotensive ones (133 vs 94 g m-2).
- A meta-analysis confirmed higher hypertrophy prevalence in hypertensive (76%) versus normotensive (50%) acromegaly.
Conclusions:
- Subclinical cardiac abnormalities, including hypertrophy and diastolic dysfunction, are frequent in asymptomatic acromegaly.
- Hypertension exacerbates cardiac hypertrophy in acromegaly.
- Early detection of cardiac changes in acromegaly is essential, even without overt heart disease.
Abstract:
Heart disease frequently occurs in advanced acromegaly. In order to investigate cardiac mass and function in acromegaly in the absence of obvious cardiac disease, we performed Doppler echocardiography in 15 asymptomatic acromegalic patients (six of them had systemic hypertension). The data were compared with those of a group of 10 age-matched controls. Left ventricular mass index (LVMI) was increased in acromegaly (110 +/- 32 vs 32 +/- 12 g m-2, P = 0.02), but shortening fraction and systolic time intervals did not differ. Mitral EF slope was decreased (80 +/- 21 vs 101 +/- 30 mms-1, P less than 0.02), while the duration of the isovolumic relaxation period (IRP) was increased (92 +/- 13 vs 69 +/- 16 ms, P less than 0.01). Hypertensive acromegalic patients (n = 6) had a higher LVMI than normotensive acromegalic patients (n = 9) (133 +/- 27 vs 94 +/- 24 g m-2, P = 0.02) and this was confirmed by a meta-analysis of data in the literature: the prevalence of hypertrophy was 76% in the presence of hypertension vs 50% in its absence, P less than 0.002. IRP was prolonged in normotensive acromegalic patients vs normal controls (90 +/- 11 vs 69 +/- 16 ms, P less than 0.01). In conclusion, subclinical cardiac abnormalities occur frequently in acromegaly in the absence of obvious heart disease, and hypertrophy is observed in asymptomatic hypertensive acromegaly. Moreover, diastolic abnormalities are found in asymptomatic acromegaly and could be caused by several heart-related factors.