Aortic stiffness is increased in acromegaly — A transthoracic echocardiographic study

Nemes, Attila; Gavallér, Henriette; Csajbók, Éva; Julesz, J.; Forster, Tamás; Csanády, Miklós

doi:10.1016/j.ijcard.2006.11.196

Cited by 22 publications

(20 citation statements)

References 18 publications

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“…They also found that large artery stiffness is reduced in cured acromegaly and partially reversed after pharmacological treatment of active disease. We presented increased echocardiographic ASI in acromegalic patients, which was similar to subjects with significant coronary artery disease without acromegaly [3]. Significantly (more than three-fold) increased ASI has been found in acromegalic patients with versus without DM [4].…”

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confidence: 67%

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Prognostic significance of aortic stiffness index in acromegaly—Results from a 4-year follow-up

Csajbók

Kalapos

Gavallér

et al. 2011

International Journal of Cardiology

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confidence: 67%

“…Direct effects of GH and IGF-1 on vasculature over traditional risk factors were suggested. In recent studies, early alterations in aortic distensibility have been demonstrated in acromegalics [2][3][4]. However, prognostic information on vascular distensibility alterations in this patient population has never been investigated.…”

mentioning

confidence: 99%

Prognostic significance of aortic stiffness index in acromegaly—Results from a 4-year follow-up

Csajbók

Kalapos

Gavallér

et al. 2011

International Journal of Cardiology

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“…2,4,5 Moreover, recent studies have also demonstrated increased aortic stiffness in patients with acromegaly without overt cardiovascular disease as compared to controls and similar to patients with significant coronary artery disease. 6,7 An emerging cardiovascular consequence of acromegaly is the increased aortic root diameter. By Doppler echocardiography, it is possible to define the presence of aortic ectasia when the aortic root diameter is ‡3AE8 cm and aneurysm when the aortic root diameter exceeds 50% of the expected limit.…”

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confidence: 99%

Aortic root ectasia in patients with acromegaly: an emerging complication*

Colao

Grasso

2011

Clinical Endocrinology

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GH excess has direct, well recognized, detrimental effects on the heart and induces a specific cardiomyopathy. 1 The most common features of acromegalic cardiomyopathy include concentric biventricular hypertrophy, left ventricular systolic and diastolic dysfunction, rhythm disturbances and an increased prevalence of valve abnormalities. 2 These cardiac complications are major determinants of the shortened life expectancy of patients with acromegaly. While cardiac structure and function have been rather widely investigated in acromegaly, vascular consequences of GH excess have scantly been assessed even if a direct effect of GH and IGF-I on vasculature over traditional risk factors has been suggested.Increase in the carotid intima-media thickness (IMT) on major arteries was reported in active as well as in cured patients with acromegaly, but the prevalence of well-defined atherosclerotic plaques was not higher than in control subjects.2 Active acromegaly has also been associated with endothelial dysfunction because of reduced nitric oxide and endothelium-derived hyperpolarizing factor bioavailability, which may contribute to the early mortality from cardiovascular disease. 3 As demonstrated, after successful treatment of acromegaly, endothelial dysfunction and IMT appears to return towards normal, suggesting an improvement in the risk of cardiovascular events. 2,4,5 Moreover, recent studies have also demonstrated increased aortic stiffness in patients with acromegaly without overt cardiovascular disease as compared to controls and similar to patients with significant coronary artery disease. 6,7 An emerging cardiovascular consequence of acromegaly is the increased aortic root diameter. By Doppler echocardiography, it is possible to define the presence of aortic ectasia when the aortic root diameter is ‡3AE8 cm and aneurysm when the aortic root diameter exceeds 50% of the expected limit. 8 The increased aortic root diameter may progressively dilate over time, leading to dissection or aortic regurgitation and it is generally accepted that a diameter greater than 6 cm is an indication for a surgical procedure. 8In this issue of the journal, Casini et al. 9 have evaluated the aortic root diameter and the prevalence of aortic ectasia in 42 patients with acromegaly and 42 healthy matched controls, demonstrating that the aortic root diameter was significantly greater in patients with acromegaly than controls with a relevant gender difference as it was significantly greater in men than in women. Interestingly and for the first time in a rather large series, the prevalence of aortic ectasia was accurately investigated so demonstrating that this condition was significantly greater in the patients with acromegaly than in the healthy population. As expected, the dimension of the heart as measured by left ventricular mass index (LVMi) was positively correlated with the diameter of the aorta, and patients with aortic ectasia presented with LVMi significantly greater than patients without this feature. Only acromegaly was assoc...

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“…'ln' is the natural logarithm Echocardiography-derived aortic elastic properties including aortic stiffness index (β or ASI) were found to be altered in acromegaly, as well [5][6][7]. Significantly (more than three-fold) increased ASI has been demonstrated in acromegalic patients with versus without diabetes mellitus (DM) suggesting that DM facilitates aortic stiffening in these patients [6].…”

mentioning

confidence: 99%

“…It has previously been reported that catecholamine plays an adverse role in inducing apoptosis in cardiomyocytes [3], and many previous clinical studies have certified that none of inotropic agents improve prognosis when administered to patients with chronic heart failure [4]. Although one review article hypothesized that possible pathophysiological mechanisms include diffuse microvascular spasms with endothelial dysfunction, which is caused by excessive catecholamine release or oxidative stress [2], it has recently been reported that Takotsubo cardiomyopathy is accompanied by impaired glucose uptake in the heart [5][6][7]. This suggests that cardiomyocytes may be very sensitive to the pathological microenvironment as a consequence of glucose utilization.…”

mentioning

confidence: 99%