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

Abstract

SummaryLeft ventricular diastolic dysfunction (LVDD) develops in the early stages of acromegaly. The purpose of this study was to identify LVDD analyzing by new echocardiograpic criteria as well as to evaluate determinants of the LVDD in acromegaly. This cross-sectional study examined 42 patients with acromegaly; 16 in active disease (AA) and 26 cured/ well controlled (CA), and compared them with 30 healthy controls (CG). Ventricular systolic and diastolic functions were studied by conventional and tissue Doppler imaging based on the E/Em ratio and myocardial performance index (MPI). Other clinical parameters possibly contributing to LVDD in acromegaly were also investigated. The prevalence of LV hypertrophy (33%) and LVDD (35.7%) were increased in acromegaly, however, there were no differences between the AA and CA groups. Acromegalic patients had higher LV volumes and LV mass, and septal E/Em ratio compared to CG, whereas LV ejection fraction and MPI were not different. The presence of acromegaly (r = 0.29, P = 0.013), diabetes mellitus (DM) (r = 0.41, P < 0.001), hypertension (r = 0.35, P = 0.002), and sleep apnea (r = 0.56, P = 0.003) were found to be correlated with LVDD, whereas duration and activity of acromegaly were not. In regression analysis, advanced age (OR: 8.53, P = 0.006) and DM (OR: 25.9, P = 0.007) were found to be independent risk factors for LVDD. The risk of LVDD according to new criteria increases in acromegaly. However, it seems to be related to the presence of DM and advanced age and is independent of disease duration and activity. ( Cardiac involvement is known to be a major determinant of the shortened life expectancy in acromegalic patients. 1,2) Increased GH, directly and via insulin like growth factor 1 (IGF-1), induces myocardial hypertrophy and fibrosis in the absence of increased wall stress.3) Left ventricular hypertrophy (LVH) causes diastolic and more rarely systolic dysfunction and arrhythmias. Echocardiographic studies of acromegalic patients have suggested left ventricular diastolic dysfunction (LVDD) in the early stages of the disease while LV systolic function was preserved. 4) However, previous studies have evaluated diastolic function by old methods including the transmitral E/A ratio. This ratio is not sufficient to evaluate the diastolic function in patients with preserved systolic function. Pulsed-wave (pw) tissue Doppler imaging (TDI) allows quantitative measurements of the myocardial contraction and relaxation velocities of a selected myocardial segment.5) The Em velocity is considered as an index of ventricular relaxation, which is relatively independent from variation of the atrial pressure and its ratio to velocity peak of transmitral flow (E/Em) is related with the LV filling pressure. The E/Em ratio is recommended at the first step for evaluation of LVDD by echocardiography according to a new guideline. 6) Peak systolic mitral annular velocity (Sm) is used to evaluate LV systolic function. Another parameter used in the evaluation of cardiac function is the myo...

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“…rheumatoid arthritis, 80 connective tissue disorders like scleroderma, 81 M. Raynaud, 55 systemic lupus erythematosus, 82 dermato/polymyositis, 83 and hypersensitivity and eosinophilic myocarditis 73,[84][85][86][87] Infiltrative Related to malignancy Direct infiltrations and metastases [88][89][90] Not related to malignancy Amyloidosis, 19,91 sarcoidosis, 92,93 primarily and secondary haemochromatosis, [94][95][96] storage diseases 97 (e.g. Fabry disease, 98,99 Danon disease, [100][101][102] Pompe disease, 99,102 PRKAG2 deficiency, 99 Gaucher's disease 99 ) 103,104,105,106 Metabolic Hormonal Such as thyroid diseases, 107,108 parathyroid diseases, 109 acromegaly, 110 GH deficiency, 111 Cushing disease, 112 Conn's disease, 113 Addison disease, 114 phaeochromocytoma, 115 pathologies related to pregnancy and peripartum 116,117 Nutritional Such as deficiencies in thiamine,…”

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Cardiovascular System Changes and Related Risk Factors in Acromegaly Patients: A Case-Control Study

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