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A hyperkinetic heart in uncomplicated active acromegaly. Explanation of hypertension in acromegalic patients?
L Thuesen1, S E Christensen, J Weeke
1University Department of Cardiology, II University Clinic of Internal Medicine, Aarhus Kommunehospital, Denmark.
Insights
Patients with active acromegaly show increased cardiac output and myocardial contractility due to augmented peripheral blood flow. This cardiac hyperkinesia may contribute to hypertension in acromegaly.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Acromegaly, a disorder caused by excess growth hormone, can lead to cardiovascular complications.
- Early cardiac changes in acromegaly are not fully understood.
Purpose of the Study:
- To investigate cardiac function in patients with active acromegaly.
- To compare cardiac parameters between acromegalic patients and healthy controls.
Main Methods:
- Echocardiography was used to assess cardiac function in 12 acromegalic patients and 12 healthy controls.
- Measurements included left ventricular mass, preload, afterload, fractional shortening, and cardiac output.
Main Results:
- Acromegalic patients had increased left ventricular mass and cardiac output (52% higher).
- Myocardial contractility (fractional shortening) was significantly higher in acromegalic patients.
- Afterload was decreased, while preload remained within normal limits in the acromegalic group.
Conclusions:
- Short-term acromegaly is characterized by cardiac hyperkinesia, likely driven by increased peripheral blood flow.
- This hyperkinetic state may be an early mechanism contributing to hypertension in acromegaly.
Abstract:
Cardiac function was studied by echocardiography in 12 patients with active acromegaly and in 12 age- and sex-matched healthy control subjects. None of the patients had cardiovascular diseases or other endocrine diseases than acromegaly. The patients had a mean age of 39 +/- 5 years and were short-term acromegalic with a mean duration of disease of 6 +/- 3 years. Mean left ventricular mass was 163 +/- 43 g/m2 in the acromegalic group versus 120 +/- 24 g/m2 in the control group. Preload (the diastolic diameter of the left ventricle) was within normal limits, while afterload (end-systolic meridional wall stress) was significantly decreased in the acromegalic group. Myocardial contractility assessed as fractional shortening of the left ventricle was 39.9 +/- 3.6% in the acromegalic group versus 32.9 +/- 5.1% in the control group, and cardiac output was increased by 52% in the acromegalic group because of increased heart rate and stroke volume. We suggest that augmented peripheral blood flow is responsible for the condition of cardiac hyperkinesia in short-term acromegaly and involved in the development of hypertension, which is a frequent complication of long-term acromegaly.