Improvement of Cardiac Function after Treatment with Octreotide followed by Trans-sphenoidal Surgery in an Acromegalic Patient who Presented with Congestive Heart Failure.

SUMMARYOctreotide, a somatostatin analogue, has been found effective in the treatment of acromegalic cardiomyopathy. We investigated whether intermittent octreotide therapy had beneficial effects in patients with ischemic or idiopathic dilated cardiomyopathy, which are refractory to conventional therapy.Twelve patients with ischemic or idiopathic dilated cardiomyopathy were enrolled in the study. In addition to conventional treatment, octreotide (first 50 µg and then 25 µg three times per day for 4 days) was administered and repeated after 1, 2, and 3 months. The patients were evaluated 3 times, before and immediately after the first treatment and after 3 months of treatment, using echocardiography, exercise stress testing, ambulatory ECG, right ventricular catheterization, cardiac enzymes, and the Minnesota living with heart failure questionnaire for quality of life.There were no significant changes in parameters after the first treatment. However, after 3 months of treatment, there were significant improvements in the left ventricular ejection fraction, left ventricular posterior wall thickness, hemodynamics, exercise capacity, and quality of life. Additionally, ischemic burden and the number of ventricular premature beats also decreased slightly.Intermittent octreotide therapy led to significant improvements in patients with ischemic and idiopathic dilated cardiomyopathy refractory to conventional treatment. We believe that this therapy should be attempted as an adjunctive therapy in these patients, and that in this respect, randomized, double-blind, clinical, and large-scale studies are required before regular usage is undertaken. (Jpn Heart J 2004; 45: 613-621)

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“…[7][8][9] Furthermore, no differences in histological findings were found between acromegalic cardiomyopathy and idiopathic DCM.…”

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confidence: 92%

The Effects of Octreotide in Dilated Cardiomyopathy: An Open-label Trial in 12 Patients

et al. 2004

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“…Both neurosurgery [14,17,18] or medical treatment with somatostatin analogs (SSA) [14][15][16][17]19] are effective in decreasing cardiac mass, leading to systolic function improvement and increasing diastolic filling capacities. Indeed, there is evidence in the literature to suggest that the improvement of acromegalic cardiomyopathy may occur during administration of octreotide regardless of ''normalization'' of GH/IGF-1 levels [16,24]. However, it is still unknown whether this discordance may be dependent on a direct effect of SSA on cardiac cells.…”

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confidence: 99%

The long-term cardiovascular outcome of different GH-lowering treatments in acromegaly

et al. 2007

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The aim of this longitudinal study was to evaluate the echocardiographic outcome of acromegalic heart disease in patients undergoing different therapeutic approaches, in order to investigate whether SSA could provide therapeutic advantages as compared with neurosurgery. In total of 36, consecutive patients undergoing SSA treatment after neurosurgery were enrolled in this study (Gr.Surg.-SSA). After 12 months of treatment, 21 patients had a controlled disease, while the remaining 15 patients displayed uncontrolled disease. Twelve acromegalic patients who did not undergo SSA treatment due to controlled disease after neurosurgery were enrolled as control group (Gr.Surg). The echocardiographic-Doppler study was performed before neurosurgery and after 12-months of follow-up. After follow-up, a significant reduction in serum GH and IGF-I values, Left Ventricular Mass index (LVMi) and LVH rate with an improvement in diastolic function was observed in both groups of patients. We found a significant reduction of LVMi either in patients with controlled disease or in those with poorly controlled disease undergoing SSA treatment. Diastolic function and of LVH percentage improved in all groups, but significantly so only in controlled patients, no significant difference in any echocardiographic parameters and in the prevalence of the LVH rate were observed between the three groups of patients at the end of follow-up. Therefore, our data appear to show that for echographic parameters medical treatment additive beneficial effects is compared to neurosurgery alone. SSA also appears to contribute to the improvement of acromegalic cardiomyopathy also in patients who did not achieve biochemical control of the disease.

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“…The normalization of GH and IGF-1 levels, whether by surgical or pharmacological therapy, is essential to reversing or arresting cardiovascular complications [5]. An earlier case report described a 43-year-old man with severe congestive heart failure produced by acromegalic cardiomyopathy who recovered significantly through octreotide followed by transsphenoidal surgery [21]. Some reports suggest that the beneficial effects obtained from hormone suppression therapy appear more significant in younger patients with short disease duration than in older patients [22].…”

Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy improves heart failure in one patient with acromegaly-induced cardiomyopathy: a case report

Wang

Liu

et al. 2019

J Med Case Reports

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Background Congestive heart failure is rarely observed in patients with acromegaly. Excessive growth hormone secretion and elevation of insulin-like growth factor 1 contribute to pathological changes in myocyte growth and structure, cardiac contractility, vascular function, and in later stage may progress to cardiac dysfunction. Early recognition of the condition is paramount, though the insidious progression of the disease commonly results in late diagnosis. Current standard regimens of pharmacological therapy, surgical treatment, radiotherapy are designed to normalize serum levels of both insulin-like growth factor 1 and growth hormone. In patients with late-stage heart failure due to acromegalic cardiomyopathy, cardiac resynchronization therapy might be a desirable treatment to help cardiac synchronization, improve symptoms, and eventually reduce hospital admissions together with mortality rates. Case presentation We describe a case of a 49-year-old man with a history of acromegaly who presented to our hospital with a diagnosis of decompensated systolic heart failure. Serial electrocardiograms showed wide (160–200 ms) QRS duration with left bundle branch block. Echocardiography showed severe left ventricular dysfunction that simultaneously achieved a left ventricular ejection fraction of 16%. Surgical indication was rarely assessed by neurosurgeons. Given that the stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects, cardiac resynchronization therapy was performed. Owing to biventricular synchronization and holding back reverse remodeling, the patient’s symptoms were successfully alleviated, and he was discharged from the hospital. Conclusions Congestive heart failure is a rare complication in acromegaly-induced cardiomyopathy (occurs in only 3% of patients). Early diagnosis and treatment with curative drugs more than cardiovascular implantable electronic devices might lead to better surgical outcomes in this group of patients.

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Improvement of Cardiac Function after Treatment with Octreotide followed by Trans-sphenoidal Surgery in an Acromegalic Patient who Presented with Congestive Heart Failure.

Cited by 6 publications

References 29 publications

The Effects of Octreotide in Dilated Cardiomyopathy: An Open-label Trial in 12 Patients

The Effects of Octreotide in Dilated Cardiomyopathy: An Open-label Trial in 12 Patients

The long-term cardiovascular outcome of different GH-lowering treatments in acromegaly

Cardiac resynchronization therapy improves heart failure in one patient with acromegaly-induced cardiomyopathy: a case report

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