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[Cardiological findings in acromegaly]
B Ferramosca1, D Bianchi, D Serra
1Università di Bologna Istituto di Patologia Speciale Medica e Metodologia Clinica.
Insights
Acromegaly patients often have subclinical cardiac issues. Echocardiography is key for detecting and monitoring these heart abnormalities, even when growth hormone (GH) levels decrease.
Area of Science:
- Cardiology
- Endocrinology
- Medical Diagnostics
Background:
- Acromegaly, caused by excess growth hormone (GH), is linked to cardiovascular complications like hypertension and diabetes.
- Cardiac decompensation and arrhythmias in acromegaly may indicate a specific GH-induced cardiomyopathy, independent of other risk factors.
Purpose of the Study:
- To assess the presence and progression of subclinical cardiac alterations in acromegaly patients.
- To evaluate the effectiveness of echocardiography in diagnosing and monitoring cardiac involvement in acromegaly.
Main Methods:
- Echocardiography was used to examine cardiac structure and function in 8 acromegaly patients.
- Patients were reassessed 2-4 years after treatment to observe changes in cardiac parameters and GH levels.
Main Results:
- Initial echocardiography revealed subclinical cardiac abnormalities, including left ventricular hypertrophy, in most patients.
- Despite some reduction in GH and IGF-1 (Insulin-like Growth Factor 1) levels post-treatment, cardiac function showed deterioration in several cases.
- Echocardiography demonstrated significant changes in diastolic diameter and ejection fraction over time.
Conclusions:
- Acromegaly patients frequently exhibit subclinical cardiac abnormalities.
- Echocardiography is a highly sensitive non-invasive tool for diagnosing and following cardiac involvement in acromegaly.
- The progression of cardiac alterations is only partially influenced by reduced GH and IGF-1 levels.
Abstract:
Acromegaly involves cardiovascular complications mostly due to the presence of hypertension, diabetes and atherosclerosis. However the appearance of cardiac decompensation and arrhythmias in the absence of predisposing factors tends to support the hypothesis of a specific myocardiopathy caused by excess GH. In order to assess the existence and course of subclinical cardiac alterations, 8 acromegaly patients were examined: 4 males and 4 females aged 31-56 with GH levels of 24-70 ng/ml (M + CD X 47 +/- 16) and no cardiovascular symptoms. One of the patients had moderate hypertension and 2 reduced glucose tolerance. The basal ECG showed sporadic ventricular extrasystoles in 2 cases and alterations compatible with left ventricular hypertrophy in another, while the effort ECG produced an asymptomatic depression of the ST segment in the hypertensive patient. The chest X-ray was normal in all cases. The echocardiography study investigated: the thickness of the interventricular septum (IVS = 13.9 +/- 2.8 mm), the thickness of the posterior wall of the left ventricle (LPW = 10.6 +/- 2.9 mm), the septum/posterior wall ratio (IVS/LPW = 1.3 +/- 0.2 the diastolic diameter (DD = 15.4 +/- 11.4 mm), the fraction of shortening (FS = 39.1 +/- 14.5%), the ejection fraction (EF = 64.1 +/- 18.4%) and revealed asymmetrical septal hypertrophy in 3 cases, concentric hypertrophy in another two. In two cases the DD and EF were distinctly altered. The patients were re-examined 2-4 years after surgical or radiation treatment. GH levels (M +/- SD = 10.3 +/- 10.1 ng/ml) were normal in 4 cases and still high, though lower in another two. The remaining two patients had borderline GH levels with high Sm-C. The ECG and chest X-ray were unchanged while echocardiography revealed a significant deterioration in heart function as far as DD (56.4 +/- 10.8 mm, p less than 0.05) were concerned with frankly pathological results in 4 and 3 cases respectively. These data confirm the view that most acromegalic patients present subclinical abnormalities in cardiac function and that the evolution of these is slightly influenced by the reduction in GH and Sm-C. levels. In fact, while the persistence of high GH and Sm-C. levels may explain the progression of cardiac alterations in some cases, it does not in others. It is also emphasised that echocardiography appears to be the most sensitive non-invasive technique for the diagnosis and follow-up of cardiac involvement in acromegaly.