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Doppler echocardiographic patterns in patients with acromegaly
M Terzolo1, L Avonto, C Matrella
1Dipartimento di Scienze Cliniche e Biologiche, Universit¿a di Torino, Italy.
Insights
Acromegaly patients show subclinical heart dysfunction, specifically left ventricular hypertrophy and impaired diastolic function, regardless of disease activity. Echocardiography reveals these cardiac changes in acromegaly, highlighting the need for cardiovascular monitoring.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Cardiovascular disease is a major cause of morbidity and mortality in acromegaly.
- Acromegaly, a condition of excess growth hormone, can lead to cardiac complications.
Purpose of the Study:
- To assess the prevalence of cardiomyopathy in acromegaly patients using echocardiography.
- To correlate echocardiographic findings with demographic, clinical, and hormonal data.
Main Methods:
- Retrospective controlled clinical trial involving 25 acromegaly patients and 50 healthy controls.
- Echocardiography to evaluate left ventricular (LV) mass, systolic, and diastolic function.
- Hormonal assessment (serum GH, plasma IGF-I) and 48-hour ECG monitoring in active cases.
Main Results:
- Left ventricular hypertrophy found in 56% of acromegaly patients.
- Significantly increased LV mass index and impaired LV diastolic function in acromegalics compared to controls.
- No significant difference in echocardiographic findings between active and cured acromegaly patients.
Conclusions:
- Acromegaly is associated with subclinical left ventricular dysfunction.
- Cardiac changes are present irrespective of disease activity (active vs. cured).
- Further cardiovascular monitoring is warranted for acromegaly patients.
Abstract:
Cardiovascular problems have long been recognized as responsible for an increased morbidity and mortality in patients with acromegaly. The aim of the present study was to evaluate echocardiographically the prevalence of cardiomyopathy in a cohort of acromegalic patients and to analyze the results in relation to demographic, clinical and hormonal data. This study, a retrospective controlled clinical trial, was performed in 25 acromegalic patients, 12 men and 13 women aged 26-66 years (mean: 52.6). Fifteen patients had an active disease, 10 were cured by previous pituitary surgery. The same echocardiographic parameters were analyzed in 50 healthy subjects aged 30-70 years (mean: 51.4). Serum GH was determined on at least 4 samples drawn over 24 hours and plasma IGF-I on a single point. Standardized parameters of diastolic and systolic function were evaluated by real-time Doppler echocardiography. Twelve patients with active acromegaly underwent also 48-hour ECG registering. Left ventricular (LV) hypertrophy was found in 14/25 patients (56%). No difference was found between patients with active disease (53%) and patients with cured acromegaly (60%). LV mass index was significantly increased in acromegalics in comparison with healthy subjects (137 +/- 43 g/m2 vs 96 +/- 16 g/m2, p < 0.01) and also the indices of LV diastolic function were significantly impaired. Asymmetric septal hypertrophy was found only in one patient. Hypertension was detected in 9/25 patients (36%) without difference between patients with active or cured disease (40% vs 30%, NS). No significant correlation was found between hormonal or clinical data and echocardiographic findings. During Holter monitoring, heart rate of acromegalics was not significantly different from that of controls (78 +/- 12 bpm vs 72 +/- 10 bpm, NS) and only isolated supraventricular or ventricular premature complexes (Lown class 1) were detected. In conclusion, this study provides evidence of subclinical LV dysfunction in acromegaly in the absence of other known causes of heart disease and no significant difference in echocardiographic pattern was apparent between active or cured acromegalics.