Endocrine Abstracts

The most frequent cause of death in acromegaly is cardiomyopathy. To evaluate determinants of the acromegalic cardiomyopathy we performed an analytical, observational, open, prospective, controlled study in 205 patients with active acromegaly (108 women and 97 men) and 205 non-acromegalic subjects sex- and age-matched with the patients. We determined the prevalence of Left Ventricular (LV) hypertrophy (LVH), diastolic and systolic dysfunction, by echocardiography- measured LV mass index (LVMi) early-to-late mitral flow velocity (E/A) and LV ejection fraction (LVEF). The role of age, estimated disease duration, BMI, GH and IGF-I levels, systolic and diastolic blood pressure, lipid profile and glucose tolerance was investigated. Compared to sex- and age-matched controls, the patients had lower BMI, E/A, LVEF, HDL-cholesterol levels and higher LVMi, total and LDL-cholesterol, triglycerides, glucose and insulin levels, HOMA-R and HOMA-β. The relative risk to develop mild [Odds ratio (OR)=2.2 (1.3–3.8) P=0.002] or severe hypertension [OR=3.2 (1.7–6.0), P<0.0001], arrhythmias [OR=3.7 (1.1–5.6), P=0.017], impaired glucose tolerance [OR=2.6 (1.5–4.6), P=0.0002], diabetes [OR=2.1 (1.2–3.8), P=0.006], LVH [OR=11.5 (7.1–19.0), P<0.0001], diastolic [OR=5.4 (3.2–9.2), P<0.0001], and systolic dysfunction [OR=6.3 (3.1–13.8), P<0.0001], was higher in acromegaly. Disease duration and systolic blood pressure level was the most important predictor of LVH (t=2.4, P=0.02) and systolic dysfunction (t=−2.8, P=0.006) while diastolic dysfunction was predicted by patient’s age (t=−3.3, P=0.001). The patients were divided into three groups based on disease duration: short (≤60 months), intermediate (60–144 months; 75 percentile) and long (>144 months). Patients with long estimated disease duration had a relative risk to present LVH 9.9 times, diastolic dysfunction 4.8 times and all cardiac complications 3 times higher than patients with shorter estimated disease duration. In conclusion the prevalence of different features of cardiomyopathy is 5.4–11.5 times higher in the acromegalic than in the non-acromegalic population. The major determinant of cardiomyopathy is disease duration.