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Acromegalic cardiomyopathy. An echocardiographic study
L Lusiani1, G Ronsisvalle, A Visonà
1Istituto di Medicina Clinica, University of Padova, Italy.
Insights
Left ventricular hypertrophy (LVH) is common in acromegaly, often appearing early. Long-term exposure to growth hormone (GH) appears to be the primary driver of this cardiac condition.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Acromegaly, a disorder caused by excess growth hormone (GH), can lead to cardiovascular complications.
- Left ventricular hypertrophy (LVH) is a potential consequence, but its prevalence and determinants in acromegaly require further clarification.
Purpose of the Study:
- To investigate the prevalence of left ventricular hypertrophy (LVH) in acromegalic patients.
- To identify potential determinants of LVH in acromegaly, including blood pressure, GH levels, and disease duration.
Main Methods:
- M-mode (2-D derived) echocardiography was used to assess left ventricular mass (LVM) and cardiac function in 18 acromegalic patients and 18 matched controls.
- Patients were stratified based on hypertension status (BP > 160/95 mmHg).
- Correlations between LVM and various clinical parameters (BP, GH, IGF-1/Sm-C, disease duration) were analyzed.
Main Results:
- A significantly higher LVM was observed in acromegalic patients (183.1 g/m2) compared to controls (130 g/m2).
- LVH (LVM > 140 g/m2) was present in 15 out of 18 acromegalic patients, versus 2 out of 18 controls.
- Concentric LVH was the predominant pattern in acromegalic patients.
- No significant correlation was found between LVM and blood pressure, GH, or IGF-1 levels.
- A significant positive correlation was identified between LVM and the duration of acromegaly (r=0.44, p<0.05).
Conclusions:
- LVH is an early and frequent finding in acromegaly.
- Factors such as body size, blood pressure, and cardiac output do not fully explain the prevalence of LVH.
- Long-term exposure to elevated GH levels appears to be the most significant determinant of LVH in acromegaly, suggesting a crucial role for metabolic factors.
Abstract:
Eighteen acromegalic patients (A) and 18 controls without clinical evidence of cardiac involvement and/or endocrine disease (C), matched for sex, age, body surface area, and blood pressure (BP), were investigated by M-mode (2-D derived) echocardiography, to clarify the prevalence and the possible determinants of left ventricular hypertrophy (LVH). Seven patients in each group were hypertensive (BP greater than 160/95 mmHg). Left ventricular mass (LVM) was 183.1 +/- 60.0 g/m2 in A and 130 +/- 25.9 g/m2 in C. A LVM above 140 g/m2 (that is the upper normal range in our laboratory) was found in 15/18 A and 2/18 C. The LVH was concentric (h/r greater than 0.45) in 12/15 A and 1/2 C. Systolic function indexes (% FS, end-systolic stress/end-systolic volume), cardiac index and total peripheral resistance index (as determined by echo) were within the normal range and similar in both groups. No correlation was found between LVM and BP, LVM and GH plasma levels, LVM and Sm-C levels. A significant correlation was found between LVM and duration of the disease (r 0.44; p less than 0.05). Our data confirm that LVH is an early and frequent finding in acromegaly. Its prevalence is not entirely accounted for by such factors as body size, BP or increased cardiac output. Metabolic factors may play a major role, and a long lasting exposition to increased GH levels seems the most relevant determinant of LVH.