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Cardiovascular aspects in acromegaly: effects of treatment
G Lombardi1, A Colao, D Ferone
1Department of Molecular and Clinical Endocrinology and Oncology, Federico II, University, Naples, Italy.
Insights
Acromegaly patients show cardiac structural changes, particularly increased left ventricular mass. Treatments like octreotide therapy can improve these abnormalities, suggesting heart disease in acromegaly is linked to growth hormone levels.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Acromegaly, a condition of excess growth hormone (GH), is linked to significant cardiovascular morbidity and mortality.
- The presence and nature of acromegalic cardiomyopathy are not fully understood, especially in uncomplicated cases.
- Comorbidities like hypertension and diabetes mellitus are common in acromegaly, potentially confounding cardiac assessments.
Purpose of the Study:
- To investigate cardiac structure and function in patients with uncomplicated acromegaly.
- To assess the effects of chronic octreotide therapy or surgery on cardiac parameters in acromegaly.
- To determine if cardiac changes in acromegaly are secondary to elevated GH and insulin-like growth factor-1 (IGF-1) levels.
Main Methods:
- Gated blood-pool cardiac scintigraphy and echocardiography were performed on 26 acromegaly patients and 15 controls.
- Cardiac assessments were repeated after 6 months of octreotide therapy or 12-24 months post-surgery.
- Left ventricular mass (LVM) was calculated; ECG, blood pressure, heart rate, GH, and IGF-1 levels were monitored.
Main Results:
- Acromegaly patients exhibited significantly higher LVM index compared to controls (P < .003).
- Hypertensive acromegaly patients had increased LVM index compared to normotensive acromegalics.
- Chronic octreotide therapy reduced GH and IGF-1 levels and improved echocardiographic structural abnormalities, but did not alter cardiac function parameters.
Conclusions:
- Significant cardiac structural changes, including increased LVM, occur in uncomplicated acromegaly.
- Chronic octreotide therapy or surgery can improve cardiac structural abnormalities in acromegaly.
- Cardiovascular disease in acromegaly appears to be a consequence of sustained high GH levels.
Abstract:
Patients with acromegaly have significant morbidity and mortality, associated with cardiovascular disease. Acromegaly is often complicated by other diseases such as diabetes mellitus, hypertension, and coronary artery disease, so the existence of acromegalic cardiomyopathy remains uncertain. Cardiac performance was investigated in patients with uncomplicated acromegaly. A subgroup of hypertensive acromegalics was also studied. In addition, the effects of chronic octreotide therapy or surgery on cardiac structure and function in acromegaly were studied. Twenty-six patients and 15 healthy controls underwent gated blood-pool cardiac scintigraphy and echocardiography at rest and during exercise. Echocardiography was repeated after 6 months of octreotide therapy (n = 11). Cardiac scintigraphy was repeated after 12 and 24 months of octreotide therapy (n = 10) or 12 to 24 months after surgery (n = 8). ECG, blood pressure, and heart rate were monitored during cardiac scintigraphy. Left ventricular mass (LVM) was calculated from the findings of the echocardiography. Serum growth hormone (GH) levels and plasma insulin-like growth factor-1 (IGF-1) levels were monitored. LVM index was significantly higher (P < .003) in acromegalics than controls and in hypertensive acromegalics than normotensives, but all other indices of cardiac function were similar. Chronic octreotide decreased GH and IGF-1 levels and improved the structural abnormalities as measured by echocardiography. Chronic octreotide or surgery did not alter cardiac function parameters. Thus, important changes in cardiac structure and function occur in uncomplicated acromegaly, and improvements can be demonstrated after chronic octreotide therapy. Heart disease in acromegaly appears to be secondary to high circulating GH levels.