Electrophysiological features in acromegaly: re-thinking the arrhythmic risk?

Parolin, Matteo; Dassiè, Francesca; Vettor, Roberto; Steeds, Richard P.; Maffei, Pietro

doi:10.1007/s40618-020-01343-0

Cited by 11 publications

(11 citation statements)

References 86 publications

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“…Several studies have attempted to elucidate the pathogenesis of VT in acromegaly. IGF‐1 has a dose‐dependent positive ionotropic effect with an increase in the intracellular calcium that contributes to early or delayed depolarizations 3 . The presence of interstitial fibrosis and myofibrillar derangement can promote arrhythmia by either electrical automaticity or rarely re‐entry.…”

Section: Discussionmentioning

confidence: 99%

Looking above the heart: A rare cause of ventricular tachycardia

Subramnaian¹,

Shah²,

Saggu³

et al. 2021

Journal of Arrhythmia

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We describe a 56‐year old man with medically refractory ventricular tachycardia (VT) who was referred for catheter ablation. His examination revealed features suggestive of acromegaly. The diagnosis was confirmed by elevated levels of insulin like growth factor‐1 and the presence of a pituitary adenoma. Following trans‐sphenoidal surgery, there was a reduction in PVC burden and no recurrence of VT.

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Section: Discussionmentioning

confidence: 99%

Looking above the heart: A rare cause of ventricular tachycardia

Subramnaian¹,

Shah²,

Saggu³

et al. 2021

Journal of Arrhythmia

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“…However, no significant arrhythmias or episodes of severe bradycardia have been reported in larger clinical trials and real-life settings. As such, we do not consider appropriate to perform closer cardiologic monitoring [37].…”

Section: Management Of Other Adverse Drug Reactionsmentioning

confidence: 99%

Clinical Management of Acromegaly: Therapeutic Frontiers and New Perspectives for Somatostatin Receptor Ligands (SRLs)

et al. 2022

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Somatostatin receptor ligands (SRLs) represent a true milestone in the medical therapy for acromegaly. The first-generation SRLs (FG-SRLs), octreotide and lanreotide, have demonstrated good efficacy in disease control and tumor shrinkage, and are still considered first-line medical therapies. The development of long-acting release (LAR) formulations has certainly improved the therapeutic tolerability of these drugs, although many patients still experience therapy-related burden. As such, new formulations have recently been developed to improve adherence and therapeutic efficacy and more solutions are on the way. In the case of FG-SRL-resistant disease, pasireotide, the only second generation SRL currently available, demonstrated superiority in disease control and tumor shrinkage compared to FG-SRLs. However, its use in clinical practice is still limited due to concern for impairment in glucose homeostasis. In this review, we discuss the news about the present and future role of SRLs in acromegaly, exploring the therapeutical frontiers of this drug class. Moreover, we provide practical guidance on the use of pasireotide, based on the data in the literature and our clinical experience.

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“…Entre los tres mecanismos conocidos en la patogénesis de las arritmias: actividad desencadenada, alteraciones del automatismo y reentrada; se plantea que la GH y el IGF-1 participan solo por medio de los dos primeros 31 , 32 .…”

Section: Complicaciones Cardiovascularesunclassified

“…En relación con arritmias fatales, solo existen reportes de casos de pacientes acromegálicos que presentaron síncope o muerte súbita 31 .…”

Section: Complicaciones Cardiovascularesunclassified

“…Estudios observacionales muestran que el 40% de los pacientes acromegálicos tienen arritmias, siendo las más comunes bigeminismo ventricular, despolarización prematura ventricular y taquicardia ventricular. La frecuencia de contracciones prematuras se incrementa con la duración de la enfermedad, mientras que la severidad se correlaciona con la masa del VI 31 , 33 .…”

Section: Complicaciones Cardiovascularesunclassified

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Complicaciones cardiovasculares asociadas a la acromegalia. Estado del arte

Concepción-Zavaleta¹,

Moreno²,

Quispe-Flores³

et al. 2022

ACM

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La acromegalia es una enfermedad rara, causada principalmente por un tumor hipofisiario secretor de hormona de crecimiento (GH), se caracteriza por tener progresión lenta y asociarse a un compromiso multisistémico, siendo el aparato cardiovascular uno de los más comprometidos, llegando, incluso, desde hace más de 10 años a representar la principal causa de muerte. Las complicaciones cardiovasculares se desarrollan como resultado de las concentraciones sanguíneas elevadas de la GH y del factor de crecimiento similar a la insulina tipo 1 (IGF-1), los cuales ejercen efectos directos e indirectos sobre el endotelio, grandes vasos, riñón y los cardiomiocitos; produciendo hipertensión arterial, enfermedad valvular, arritmia cardiaca y una cardiopatía propia de la acromegalia denominada miocardiopatía acromegálica. Luego de la revisión bibliográfica actualizada relacionada con la fisiopatología, manifestaciones clínicas, diagnóstico y tratamiento del compromiso cardiovascular, encontramos que desde el punto de vista cardiovascular los pacientes con acromegalia pueden variar desde un estado asintomático hasta presentar disfunción cardiaca severa, siendo los marcadores bioquímicos y exámenes de imagen herramientas diagnósticas que permiten evaluar el grado de afección cardiovascular para poder brindar un tratamiento individualizado. La normalización de los valores de la GH y del IGF-1 mejora los parámetros cardiovasculares y, por tanto, su pronóstico.

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Electrophysiological features in acromegaly: re-thinking the arrhythmic risk?

Cited by 11 publications

References 86 publications

Looking above the heart: A rare cause of ventricular tachycardia

Looking above the heart: A rare cause of ventricular tachycardia

Clinical Management of Acromegaly: Therapeutic Frontiers and New Perspectives for Somatostatin Receptor Ligands (SRLs)

Complicaciones cardiovasculares asociadas a la acromegalia. Estado del arte

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