Cardiomyopathy in Patients With Acromegaly - Not Truly a Concern Anymore?
Peter Wolf1, Luigi Maione2, Peter Kamenický2
1Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism Vienna 1090, Austria.
Insights
Acromegaly treatment has significantly improved survival by managing cardiovascular risks. Modern therapies reduce mortality, making heart failure risk comparable to the general population when the condition is well-controlled.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Acromegaly, caused by excessive growth hormone (GH) and insulin-like growth factor-I (IGF-I), historically led to high mortality, primarily due to cardiovascular and metabolic issues.
- Cardiovascular comorbidities were considered the leading cause of death in acromegaly patients.
Purpose of the Study:
- To review the impact of GH/IGF-I excess and its treatment on cardiovascular risk factors.
- To analyze morphological and functional cardiac changes in acromegaly patients.
- To discuss evolving prevalence rates of cardiac manifestations over time.
Main Methods:
- Review of existing literature on acromegaly, GH/IGF-I excess, and cardiovascular outcomes.
- Analysis of studies examining cardiac morphology and function using various imaging techniques.
- Epidemiological data analysis on mortality and heart failure risk.
Main Results:
- While morphological cardiac changes like myocardial hypertrophy and chamber enlargement are common in acromegaly, clinically significant dysfunction is infrequent.
- Valvular heart disease and arrhythmias are noted, but clinically relevant cardiomyopathy is less prevalent than previously thought.
- Recent data indicate that the risk of heart failure in treated acromegaly patients is similar to that of the general population, considering disease control and other risk factors.
Conclusions:
- Advances in GH/IGF-I-lowering therapies and improved management of risk factors have substantially reduced mortality in acromegaly.
- Overt cardiac dysfunction and clinically significant cardiomyopathy are less common in acromegaly than historical estimates suggest.
- Effective management of acromegaly leads to cardiovascular risk profiles comparable to the general population.
Abstract:
Acromegaly is associated with increased mortality rates if not adequately treated. Cardiovascular and metabolic comorbidities are highly prevalent and have long been considered the main cause of death among patients with acromegaly. However, substantial advances in GH/IGF-I-lowering treatment, together with increased awareness and optimized management of other risk factors, have led to major improvements in mortality rates in the 2-3 past decades. Here, we review the effects of chronic excessive GH/IGF-I production and the successful treatment of this condition on relevant classical cardiovascular risk factors and on morphological and functional changes in the heart and discuss differences in reported prevalence rates over time according to different imaging methodologies used. Although morphological alterations (ie, myocardial hypertrophy as well as increased atrial and ventricular volumes) are common in patients with acromegaly, overt clinically relevant dysfunction is rare. Valvular cardiac disease and arrhythmia are also reviewed. Clinically relevant cardiomyopathy is currently less common than previously estimated. Recent epidemiological studies have shown that the risk of heart failure is comparable to that of the general population after adjusting for biochemical disease control and other risk factors.
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