Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Abstract

To determine whether the echocardiographic presentation allows for diagnosis of acromegalic cardiomyopathy. 140 patients with acromegaly underwent echocardiography as part of routine diagnostics. The results were compared with the control group comprising of 52 age- and sex-matched healthy volunteers. Patients with acromegaly presented with higher BMI, prevalence of arterial hypertension, and glucose metabolism disorders (i.e., diabetes and/or prediabetes). In patients with acromegaly, the following findings were detected: increased left atrial volume index, increased interventricular septum thickness, increased posterior wall thickness, and increased left ventricular mass index, accompanied by reduced diastolic function measured by the following parameters: E'med., E/E', and E/A. Additionally, they presented with abnormal right ventricular systolic pressure. All patients had normal systolic function measured by ejection fraction. However, the values of global longitudinal strain were slightly lower in patients than in the control group; the difference was statistically significant. There were no statistically significant differences in the size of the right and left ventricle, thickness of the right ventricular free wall, and indexed diameter of the ascending aorta between patients with acromegaly and healthy volunteers. None of 140 patients presented systolic dysfunction, which is the last phase of the so-called acromegalic cardiomyopathy. Some abnormal echocardiographic parameters found in acromegalic patients may be caused by concomitant diseases and not elevated levels of GH or IGF-1 alone. The potential role of demographic parameters like age, sex, and/or BMI requires further research.

Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods

“…These findings are consistent with other studies. Popielarz-Grygalewicz et al ( 21 ) also noted significant LA enlargement in acromegalic patients (LAVI 41.4 vs. 29.9 ml/m 2 ; p < 0.001).…”

“…Both of these pose a risk of LV diastolic and systolic dysfunction. Recent studies have shown impaired LV systolic function in acromegalic patients assessed using both standard methods and new echocardiography methods such as speckle-tracking echocardiography ( 21 , 22 ). In our study, the ACRO group presented a higher LV mass, impaired LV systolic function, and mitral annulus velocity (e′).…”

“…The reports on GLS in acromegaly are not entirely consistent. Popielarz-Grygalewicz et al (21) examined 140 acromegalic patients with normal LV systolic function measured by LVEF with GLS slightly lower than in the control group (19.2 vs. 20.7%; p < 0.01). Di Bello et al (23) found that the acromegalic heart showed impaired LV systolic function assessed by systolic strain and systolic strain rate.…”

Acromegaly and ultrasound: how, when and why?

“…On the other hand, these results were not confirmed by Volschan et al, who did not reveal strain impairment [25]. The end stage of acromegaly cardiomyopathy is characterized by ventricular dilatation with systolic dysfunction [26,27]. This is a rare condition, but some cases have been reported in the literature, including in some younger patients [28,29].…”

Tercer Consenso Nacional de Acromegalia: recomendaciones para su diagnóstico, tratamiento y seguimiento

“…La mayoría de las series evalúan los diferentes componentes de la ECV con ultrasonido 32 . En años recientes se ha empleado la resonancia magnética nuclear cardiaca (RMC); en estos estudios se informa una menor prevalencia de hipertrofia de ventrículo izquierdo y de fibrosis miocárdica, lo que hace suponer que los estudios ecocardiográficos sobreestiman su frecuencia.…”