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The effect of first intervention on cardiac parameters in patients with acromegaly: a systematic review
Kevin A Huynh1,2,3, Jin Al-Gully1,2,4, José M Montero-Cabezas4
1Division of Endocrinology, Department of Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Insights
Growth hormone-lowering treatments improve cardiac structure and function in acromegaly patients. Achieving biochemical remission is crucial for better cardiac outcomes and preventing further heart disease progression.
Area of Science:
- Endocrinology
- Cardiology
- Systematic Review
Background:
- Acromegaly, a condition of excess growth hormone, significantly increases cardiovascular disease risk, a leading cause of mortality.
- Cardiac manifestations include left ventricular hypertrophy and impaired function, contributing to morbidity and mortality.
Purpose of the Study:
- To systematically review the impact of the first growth hormone-lowering intervention on cardiac parameters in acromegaly patients.
- To evaluate changes in cardiac structure and function following primary treatment modalities.
Main Methods:
- Systematic review of 26 studies (17 cohort, 9 case reports) published up to February 2022.
- Included primary treatments: surgery and somatostatin receptor ligands.
- Assessed cardiac structure (LVH, LVM/LVMi) and function (LVEF, E/A ratio).
- Risk of bias assessed using modified Newcastle-Ottawa Scale and JBI checklists.
Main Results:
- Most studies showed improvement in cardiac structure and function post-intervention.
- Significant decreases in left ventricular mass (9/15 studies) and LVH prevalence (3/13 studies) were observed.
- Significant increases in LVEF (9/14 studies) and E/A ratio (6/7 studies) were noted.
- Cardiac structure improved more in patients achieving biochemical remission.
Conclusions:
- Both medical and surgical treatments improve acromegaly-related cardiac changes.
- Normalizing or reducing growth hormone/IGF-1 levels is key to preventing cardiac progression and adverse outcomes.
Objective:
Cardiovascular disease in acromegaly patients remains a major cause of morbidity and all-cause mortality. This systematic review investigates the effect of the first growth hormone-lowering intervention on cardiac parameters.
Design:
Systematic review.
Methods:
Studies evaluating cardiac parameters following the first intervention in acromegaly published up to February, 25, 2022 were included in this systematic review. Risk of bias was assessed using a modified Newcastle-Ottawa Scale and Joanna Briggs Institute Critical Appraisal Checklist. Primary treatment modalities included (transsphenoidal) surgery and medical treatment with first-generation somatostatin receptor ligands. Cardiac outcome measures were divided into cardiac structure (left ventricular hypertrophy [LVH], [indexed] left ventricular mass [LVM/LVMi]) and cardiac function (left ventricular ejection fraction [LVEF] and E/A ratio).
Results:
Twenty-six studies (17 cohort studies and 9 case reports) were included out of 2541 potential studies. The risk of bias analysis categorized, 24 studies as low risk and 2 studies as intermediate risk. Disease-associated changes in cardiac structure and function generally improved in most studies following primary treatment. Left ventricular mass/left ventricular mass index significantly decreased in 9/15 studies and the prevalence of LVH in 3/13 studies. Left ventricular ejection fraction significantly increased in 9/14 studies and the E/A ratio in 6/7 studies. Despite the limited number of studies, cardiac structure improved more in patients achieving biochemical remission than in those failing to achieve biochemical remission.
Conclusions:
Acromegaly associated structural and functional myocardial changes improve with both medical and surgical treatment. Normalizing or even reducing growth hormone/insulin-like growth factor 1 levels may be key in the prevention of further progression of cardiac involvement in acromegaly and adverse cardiac outcomes.
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