Related Experiment Videos
Long-term echocardiographic follow-up of acromegalic heart disease
1Third Department of Medicine, Charles University, Prague, Czech Republic.
Insights
Acromegaly
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Acromegaly commonly causes heart muscle disease, primarily cardiac hypertrophy.
- Previous studies suggested slow reversibility of cardiac hypertrophy after growth hormone normalization.
Purpose of the Study:
- To prospectively investigate the reversibility of heart muscle disease in acromegaly during and after treatment.
- To assess cardiac changes in relation to growth hormone activity over a 10-year period.
Main Methods:
- Prospective echocardiographic examination of 78 acromegaly patients in 1981, with 38 survivors re-examined 10 years later.
- Patients categorized into four groups based on growth hormone activity: consistently inactive, consistently active, inactive with resurgence, and active with normalization.
- Analysis of echocardiographic parameters including left ventricular wall thickness, mass, and volumes.
Main Results:
- No significant cardiac changes in consistently inactive patients.
- Progressive cardiac hypertrophy and increased left ventricular mass in consistently active patients.
- Significant increases in left ventricular posterior wall thickness, mass, and diastolic volume in patients with relapsed hypersecretion.
- Significant decreases in left ventricular mass and volumes in patients who achieved growth hormone level normalization.
Conclusions:
- Cardiac hypertrophy and dilatation in acromegaly are slowly reversible following successful treatment and normalization of growth hormone levels.
- Continued or relapsed hyperproduction of growth hormone leads to further deterioration of acromegalic heart disease.
Abstract:
Heart muscle disease in acromegaly manifests usually as cardiac hypertrophy. Based on a retrospective analysis, it was suggested that cardiac hypertrophy is slowly reversible after normalization of plasma growth hormone levels. The reversibility of acromegalic heart muscle disease during and after treatment of acromegaly was studied prospectively. A cohort of 78 patients was examined echocardiographically in 1981, and 38 survivors of this group were reexamined 10 years later. Patients were classified according to original hormonal activity in 1981, and change in hormonal activity during follow-up into the following 4 groups: group I--hormonally inactive for entire follow-up (n = 10); group II--hormonally active for entire follow-up (n = 11); group III--initially hormonally inactive with later resurgence (n = 6); and group IV--initially hormonally active with later normalization of growth hormone levels (n = 11). No significant echocardiographic changes occurred during follow-up in group I. Left ventricular posterior wall and septal diastolic thickness, and left ventricular mass increased significantly (all p < 0.05) in group II. Left ventricular posterior wall thickness, mass and diastolic volume increased significantly (p < 0.05, < 0.01 and < 0.001, respectively) in group III. On the contrary, there were significant decreases in left ventricular mass, and both diastolic and systolic left ventricular volumes (p < 0.01, < 0.05 and < 0.05, respectively) in group IV. It is concluded that both hypertrophy and dilatation of the left ventricle in acromegaly are slowly reversible after successful treatment. On the contrary, continuing or relapsed hyperproduction of growth hormone causes further deterioration of acromegalic heart disease.