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Impact of transsphenoidal surgery on asymptomatic cardiomyopathy in patients with acromegaly. A single-blinded study
Anirudh Srinivasan1, Ajay Bahl2, Hemant Bhagat3
1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Transsphenoidal surgery in acromegaly patients significantly improves cardiac function, reducing left ventricular mass and improving ejection fraction. Lowering growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels is key to these cardiovascular benefits.
Area of Science:
- Cardiology
- Endocrinology
- Neurosurgery
Background:
- Acromegaly significantly increases mortality risk, primarily due to cardiovascular complications.
- Limited echocardiographic data exists on cardiac function improvements after transsphenoidal surgery (TSS) for acromegaly.
Purpose of the Study:
- To assess echocardiographic changes in cardiac function following transsphenoidal surgery (TSS) in acromegaly patients.
- To correlate biochemical cure with improvements in cardiac indices, including left ventricular mass and ejection fraction.
Main Methods:
- Preoperative and postoperative echocardiography (including 3D ECHO and tissue Doppler) were performed to assess cardiac indices.
- Biochemical cure was defined by suppressed growth hormone (GH) and normal insulin-like growth factor 1 (IGF-1) levels at 6 months post-surgery.
- Prospective (38 patients) and retrospective (62 patients) cohorts were analyzed for changes in left ventricular mass index (LVMI) and ejection fraction (EF).
Main Results:
- In the prospective group, significant reductions in LVMI and improvements in EF were observed in patients with controlled GH levels post-TSS.
- Left ventricular systolic function normalized or improved in the majority of patients postoperatively.
- In the retrospective group, biochemically cured patients showed a significant improvement in EF after a mean follow-up of 20.3 months.
Conclusions:
- Reduction in GH and IGF-1 levels post-TSS contributes to decreased left ventricular mass and improved cardiac function in acromegaly.
- These cardiac improvements may lead to a reduction in the excess mortality associated with acromegaly.
Background:
Patients with acromegaly have 2-3 times the expected mortality rates primarily due to cardiovascular risks. Echocardiographic studies showing improvement of cardiac function following transsphenoidal surgery (TSS) are limited.
Materials And Methods:
All patients with acromegaly underwent preoperative echocardiography and tissue Doppler (Philips i33, 3D ECHO) for assessment of cardiac indices. In the prospective group of patients, echocardiography was repeated after 6 months of surgery. In the retrospective group of patients, echocardiography was performed for left ventricular diastolic dysfunction and ejection fraction. Biochemical cure was confirmed at least after 6 months by glucose-suppressed plasma growth hormone (GH) concentrations (GH-OGTT) of less than 0.4 ng/ml, random GH of less than 1 ng/ml, and normal age-corrected insulin-like growth factor (IGF-1) values.
Results:
In the prospective group (38 patients), there was a significant decrease in the left ventricular mass (LVM) and LVM index (LVMI) in patients who were cured as well as in patients with postoperative growth hormone (GH) 1-5 ng/ml. In the prospective group, LVMI completely normalized in 2 and a new-onset deterioration was detected in 1 patient (who was not cured) and improved in 8 others. Left ventricular systolic function was abnormal at baseline in 18 (47.3%) patients, which normalized in 11 (61.1%) patients postoperatively, and in 7 patients, it improved significantly although it did not normalize completely. There was also a significant improvement in the left ventricular ejection fraction (P = 0.01). Post TSS, in patients with GH-OGTT >5 ng/ml, there was no significant decrease in the LVM, LVMI and ejection fraction (EF). In the retrospective group, 62 patients were analyzed for a change in the EF with a mean follow-up of 20.3 months. There was a significant improvement in the left ventricular EF in patients who were cured (P < 0.001).
Conclusion:
Reduction in growth hormone levels and insulin-like growth factor type 1 can decrease the LVM and LVMI, which directly or indirectly contributes to the improvement in diastolic as well as systolic function and probably mortality.
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