Aortic Valve Annular Features in Acromegaly-A Detailed Three-Dimensional Speckle-Tracking Echocardiographic Analysis...

Background: Acromegaly, typically caused by growth hormone (GH)-secreting pituitary adenomas, leads to chronic GH and insulin-like growth factor-1 overproduction, resulting in significant cardiovascular complications, including left ventricular (LV) hypertrophy, myocardial fibrosis, diastolic/systolic LV dysfunction, and frequent valvular disease. Although aortic root dilation has been documented, the morphology and function of the aortic valve annulus (AVA) and its relationship with LV performance remain unexplored. Methods: The present study comprised a total of 31 patients with acromegaly, from which eight subjects were excluded due to inferior image quality. The remaining group of acromegalics consisted of 23 cases (mean age: 54.3 ± 14.5 years, 6 males). Their results were compared to 31 age- and gender-matched healthy subjects (mean age: 50.0 ± 7.4 years, 9 males). Cardiac assessment involved routine two-dimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography (3DSTE) to quantify basal regional and global longitudinal strains. Detailed planimetric measurements of AVA dimensions and its spatial displacement, called AVA plane systolic excursion (AAPSE), were also obtained. Results: Among 12 patients with inactive acromegaly, 7 patients (58%) showed larger end-systolic AVA area (AVA-A), while 5 patients (42%) had larger end-diastolic AVA-A. Among the 11 patients with active acromegaly, 3 patients (27%) had larger end-systolic AVA-A and 5 patients (45%) had larger end-diastolic AVA-A, while in 3 patients (27%) end-systolic and end-diastolic AVA-A proved to be equal. All end-systolic and end-diastolic AVA dimensions were tendentiously greater in acromegaly, with more pronounced values seen in the presence of an active disease. AAPSE was reduced both in all acromegaly patients and in those with active disease compared to controls. From LV strains, basal and global LV longitudinal strain (LS) and basal LV circumferential strain (CS) were similar when comparing acromegaly patients and those with active and inactive disorder to controls. However, basal and global LV-LS tended to be reduced, while basal LV-CS tended to be increased. Significantly increased global LV-CS were present in active acromegaly patients compared to inactive acromegaly patients and controls Conclusions: Significant aortic valve annular dilation is present in acromegaly, which is associated with its reduced spatial systolic displacement.