Cardiovascular comorbidities in acromegaly: an update on their diagnosis and management

Abstract

Comorbidities related to the cardiovascular system are one of the most prevalent in patients with acromegaly, and contribute to an increased risk of morbidity and all-cause mortality. Specifically, hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, coronary artery disease, and cardiac dysfunction may be frequent findings. Although the underlying physiopathology for each comorbidity may not be fully elucidated, uncontrolled growth hormone/insulin-like growth factor 1 excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors are significant influencing variables. A simple diagnostic approach to screen for the presence of these comorbidities may allow prompt treatment and arrest the progression of cardiac abnormalities. In this article, we revise the most prevalent cardiovascular comorbidities and their pathophysiology in acromegalic patients, and we address some recommendations for their prompt diagnosis, management and treatment. Strengths and pitfalls of different diagnostic techniques that are currently being used and how different treatments can affect these complications will be further discussed.

Three‐dimensional speckle tracking echocardiography–derived left atrial deformation analysis in acromegaly (Results from the MAGYAR‐Path Study)

“…All acromegalic patients and negative control subjects underwent a complete two-dimensional (2D) transthoracic echocardiographic assessment using a Toshiba Artida imaging system (Toshiba Medical Systems, Tokyo, Japan) with a PST-30SBP (1)(2)(3)(4)(5) phased array transducer. According to routine clinical standards, complete 2D Doppler study was performed in all cases including quantification of LV dimensions, volumes, ejection fraction, and LA dimensions.…”

“…Cardiovascular complications are associated with the long‐term presence of GH and insulin‐like growth factor I (IGF‐I) and are the most common causes of morbidity and mortality in acromegaly . Hypertension, left ventricular hypertrophy (LVH), and consequent heart failure are among the most common cardiovascular complications of acromegaly, but specific arrhythmias and mitral valve regurgitation can also occur …”

Left ventricular twist is impaired in acromegaly: Insights from the three‐dimensional speckle tracking echocardiographic MAGYAR‐Path Study

“…In rare cases, arrhythmias and sudden death may occur. The severity of these cardiac complications is directly related to the overall duration of elevated GH secretion rather than to the GH or IGF‐1 levels themselves …”

“…The severity of these cardiac complications is directly related to the overall duration of elevated GH secretion rather than to the GH or IGF-1 levels themselves. 4,5 In healthy subjects, the complex contraction of 2 orthogonally oriented muscular bands of the LV helical myocardium structure is responsible for the LV apex counterclockwise rotation while simultaneously causing the basis to rotate in a clockwise direction. 6-8 This…”

Current Views on the Treatment of Acromegaly With Somatostatin Analogues

“…Понятие «биохимический контроль» при акромегалии определяется строгими гормональными критериями, которые должны достигаться и поддерживаться в течение всей жизни пациента: уровень гормона роста (ГР) при однократном определении должен быть менее 2 нг/мл при использовании стандартных наборов или менее 1 нг/мл при использовании сверхчувствительных наборов; минимальный уровень ГР в ходе теста с нагрузкой глюкозой 1 должен быть менее 1 нг/мл при использовании стандартных наборов или менее 0,4 нг/мл при использовании сверхчувствительных наборов; уровень ИРФ-1 должен соответствовать референсным значениям, соответствующим полу и возрасту пациента [1,2,6,7]. Эти биохимические критерии были выработаны в ходе длительных эпидемиологических исследований, которые показали, что при поддержании именно таких уровней ГР и ИРФ-1 у пациентов с акромегалией продолжительность жизни становится сопоставимой с популяционными показателями, в том числе снижается смертность от кардиоваскулярных и онкологических заболеваний -ведущих причин смертности при акромегалии [8,9].…”