Determinants of cardiac disease in newly diagnosed patients with acromegaly: results of a 10 year survey study

Abstract

Context: The most frequent cause of death in acromegaly is cardiomyopathy. Objective: To evaluate determinants of acromegalic cardiomyopathy. Design: Observational, open, controlled, retrospective study. Subjects: Two hundred and five patients with newly diagnosed active acromegaly (108 women and 97 men; median age 44 years) and 410 non-acromegalic subjects sex-and age-matched with the patients. Main outcome measures: Left ventricular (LV) mass index (LVMi), transmitral inflow early-to-atrial (E/A) peak velocity ratio, and LV ejection fraction (LVEF) were measured by Doppler echocardiography to determine the prevalence of LV hypertrophy (LVH), diastolic and systolic dysfunction. The role of age, estimated disease duration, body mass index, GH and IGF1 levels, systolic and diastolic blood pressure, lipid profile and glucose tolerance in determining different features of the acromegalic cardiomyopathy was investigated. Results: Compared with controls, the patients had lower E/A, LVEF, high-density lipoprotein (HDL)-cholesterol levels and higher LVMi, total-and low-density lipoprotein (LDL)-cholesterol, triglycerides, glucose and insulin levels, homeostatic model assessment of insulin resistance (HOMA-R) and HOMA-b. The relative risk to develop mild (odds ratio (OR)Z1.67 (1.05-2.66); PZ0.027) or severe hypertension (ORZ1.58 (1.04-2.32); PZ0.027), arrhythmias (ORZ4.93 (1.74-15.9); PZ0.001), impaired fasting glucose/impaired glucose tolerance (ORZ2.65 (1.70-4.13); P!0.0001), diabetes (ORZ2.14 (1.34-3.40); PZ0.0009), LVH (ORZ11.9 (7.4-19.5); P!0.0001), diastolic (ORZ3.32 (2.09-5.31); P!0.0001) and systolic dysfunction (ORZ14.2 (6.95-32.2); P!0.0001), was higher in acromegaly. The most important predictor of LVH (tZ2.4, PZ0.02) and systolic dysfunction (tZK2.77, PZ0.006) was disease duration and that of diastolic dysfunction was patient's age (tZK3.3, PZ0.001). Patients with an estimated disease duration of O10 years had a relative risk to present cardiac complications three times higher than patients with estimated disease duration %5 years. Conclusions: The prevalence of different features of cardiomyopathy is 3.3-14.2 times higher in the acromegalic than in the non-acromegalic population. The major determinant of cardiomyopathy is disease duration.

Active acromegaly is associated with decreased hs-CRP and NT-proBNP serum levels: insights from the Belgian registry of acromegaly

“…Conflicting data exist about the effect of acromegaly on lipid levels. Some studies indicate a worse lipid profile in active acromegaly (9,24) while other authors reported better values (22,25,26) and a worse profile after therapy (26). We found total cholesterol and triglycerides to be significantly lower both in controlled and non-controlled acromegaly.…”

Evaluation of Left Ventricular Diastolic Function According to New Criteria and Determinants in Acromegaly

“…21) Concordant with our study, patient age was found to be the most important predictor of LVDD in acromegaly in a recent survey study with a large sample size. 22) Hypertension and LVH are major determinants of LVDD. Cardiac walls are thickened, but cardiac chambers are rarely enlarged, an event resulting from the relative increase in cardiac myocyte width, due to the parallel assembling of new contractile protein units.…”

Malignant ventricular tachycardia in acromegaly: a case report

“…Scattered spots and flaky hyperintensity in T1 and T2, apparently normal heart. 13 Therefore, when occurrences of clinical arrhythmias and heart failure are not easily explained by cardiogenic causes, it seems reasonable to consider the possibility of acromegaly-associated cardiovascular complications.…”