Low Frequency of Cardiomyopathy Using Cardiac Magnetic Resonance Imaging in an Acromegaly Contemporary Cohort

Silva, Cintia Marques dos Santos; Gottlieb, Ilan; Volschan, Isabela; Kasuki, Leandro; Warszawski, Leila; Lima, Giovanna Aparecida Balarini; Xavier, Sérgio Salles; Pedrosa, Roberto Coury; Neto, Leonardo Vieira; Gadelha, Mônica R.

doi:10.1210/jc.2015-2675

Cited by 56 publications

(41 citation statements)

References 35 publications

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“…The EF was normal in all patients, and only 5% were diagnosed with left ventricular hypertrophy. The examination was repeated after 12 months of treatment, but there were no statistically significant differences in the obtained results independently of the dynamics of the GH and IGF-1 values, indicating biochemical disease control [ 24 ]. Fazeli et al expressed similar doubts regarding the influence of GH and IGF-1 on the cardiovascular system.…”

Section: Discussionmentioning

confidence: 99%

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

Popielarz-Grygalewicz

Gąsior

Konwicka

et al. 2018

International Journal of Endocrinology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Popielarz-Grygalewicz

Gąsior

Konwicka

et al. 2018

International Journal of Endocrinology

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“…The pathophysiology underlying cardiac involvement in acromegaly is not clearly understood, elevated GH serum levels and consequent plasma volume expansion and direct anti‐natriuretic effect, increased peripheral vascular resistance may be the cause. LVH and myocardial fibrosis are considered common findings in acromegalic cardiomyopathy in echocardiography studies . However, there is limited information on LA function in acromegaly …”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional speckle tracking echocardiography–derived left atrial deformation analysis in acromegaly (Results from the MAGYAR‐Path Study)

et al. 2018

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Introduction Acromegaly is a chronic and disfiguring hormonal disease caused by a benign growth hormone‐secreting pituitary adenoma in most of the cases. The objective of this study was to investigate three‐dimensional (3D) speckle tracking echocardiography (3DSTE)‐derived left atrial (LA) volumetric and functional properties in patients with acromegaly. It was also examined whether the activity of acromegaly is associated with further alterations in these LA parameters. Methods A total of 23 patients with acromegaly were involved in this study. Due to inadequate image quality, 4 patients were excluded from the 3DSTE analysis. The mean age of the remaining acromegalic subjects was 58.5 ± 13.1 years (7 males). The control group consisted of 21 age‐ and gender‐matched healthy subjects (mean age 51.8 ± 10.3 years, 10 males). Results Maximum (44.8 ± 12.7 mL vs 78.7 ± 25.4 mL, P < .05), minimum (24.1 ± 9.0 mL vs 44.5 ± 15.5 mL, P < .05), and preatrial contraction (35.5 ± 11.2 mL vs 66.0 ± 22.8 mL, P < .05) LA volumes were significantly different between all acromegaly patients compared with controls. Increased peak global and mean segmental radial and 3D strains and decreased LA circumferential strain (CS) could be detected in all acromegaly patients as compared to healthy subjects. Significant correlation could be detected between insulin‐like growth factor 1 (IGF‐1) index and peak superior LA‐CS (r = .49, P = .05) in acromegaly. Conclusion Acromegaly is associated with increased LA volumes and changes in LA functional properties.

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“…Bogazzi et al (22) demonstrated that acromegaly patients with controlled disease after using somatostatin analogs had a greater reduction in the LV mass index than those without controlled disease. dos Santos Silva et al (23) found no clinically relevant cardiac improvements after medical therapy with octreotide. Andreassen et al (21), however, reported a decrease in cardiac function 3 months after treatment.…”

Section: Introductionmentioning

confidence: 96%

“…Evaluations of the heart with the gold standard cardiovascular magnetic resonance (CMR) offer objective and reproducible results, and CMR can precisely assess cardiac structure and function and even evaluate parameters that are difficult to precisely assess by echocardiography, such as myocardial fibrosis and ventricular volumes (16)(17)(18)(19). Several studies have used CMR to evaluate cardiac involvement in acromegaly patients (20)(21)(22)(23)(24)(25), and the results of these studies showed that the incidence rates of myocardial fibrosis, left ventricular (LV) systolic dysfunction (LVSD), and LV hypertrophy in acromegaly patients were 0% to 14.8%, 0% to 12.5%, and 5% to 72%, respectively. Some of these studies focused on the posttreatment reversibility of cardiac involvement, but the results are controversial.…”

Section: Introductionmentioning

confidence: 99%

Reversibility of Cardiac Involvement in Acromegaly Patients After Surgery: 12-Month Follow-up Using Cardiovascular Magnetic Resonance

Guo

Cao

et al. 2020

Front. Endocrinol.

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Purpose: Cardiac comorbidity is one of the leading causes of death among acromegaly patients. We aimed to investigate the reversibility of acromegalic cardiac involvement after surgical treatment using the gold standard method, cardiovascular magnetic resonance, and to explore the effects of endocrine remission and gender on reversibility. Methods: In this single-center, prospective cohort study, fifty untreated acromegaly patients were enrolled. Comprehensive cardiac assessments were performed using a 3.0 T magnetic resonance scanner before and 3 and 12 months after transsphenoidal adenomectomy. Results: Preoperatively, left ventricular (LV) enlargement (13.0%), LV systolic dysfunction (6.5%), right ventricular (RV) enlargement (4.3%), RV systolic dysfunction (2.2%) and myocardial fibrosis (12.0%) were identified. On average, the LV and RV ejection fractions of acromegaly patients were higher than the healthy reference values. Male patients had thicker LV myocardia, wider ventricular diameters and more dilated pulmonary artery roots than female patients. After surgery, LV myocardial hypertrophy was reversed, the left atrium was remodeled, and ventricular systolic dysfunction recovered to normal. Cardiac alterations were detected early in the 3 rd postoperative month and persisted until the 12 th month. The interventricular septum was initially thickened in the 3 rd postoperative month and then recovered at the 12th month. Notable postoperative cardiac reversibility was observed in male patients but did not occur in all female patients. Patients achieving endocrine remission with normalized hormone levels had thinner LV myocardia than patients without normalized hormone levels. Conclusion: Our findings demonstrated that some of the cardiac involvement in acromegaly patients is reversible after surgical treatment which lowers hormone levels. Endocrine remission and gender significantly impacted postoperative cardiac reversibility.

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Low Frequency of Cardiomyopathy Using Cardiac Magnetic Resonance Imaging in an Acromegaly Contemporary Cohort

Abstract: We demonstrated by CMRi, the gold-standard method, that patients with active acromegaly might have a lower prevalence of cardiac abnormalities than previously reported.

Cited by 56 publications

References 35 publications

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

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

Three‐dimensional speckle tracking echocardiography–derived left atrial deformation analysis in acromegaly (Results from the MAGYAR‐Path Study)

Reversibility of Cardiac Involvement in Acromegaly Patients After Surgery: 12-Month Follow-up Using Cardiovascular Magnetic Resonance

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