ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 OC1.5

Cardiac performance after long-term treatment with Pegvisomant in patients with acromegaly: a radionuclide angiography study

Renata Simona Auriemma1, Maria Cristina De Martino1, Mariano Galdiero1, Wanda Acampa2, Monica De Leo1, Gaetano Lombardi1, Alberto Cuocolo2, Annamaria Colao1 & Rosario Pivonello1

1Department of Clinical and Molecular Endocrinology and Oncology, University ‘Federico II’, Naples, Italy; 2Department of Nuclear Medicine, University ‘Federico II’, Naples, Italy.

GH and IGF-I excess causes a specific cardiomyopathy, often complicated by diastolic and systolic dysfunction until heart failure. The aim of this study is to evaluate the effects of long-term treatment with pegvisomant on cardiac performance in acromegalic patients. Twelve patients (4 men and 8 women, age 29–58 years) entered the study. A radionuclide angiography at rest and during exercise was performed at baseline and after 18 months of treatment with pegvisomant with evaluation of heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, peak filling rate (PFR), peak ejection rate (PER), PFR/PER ratio and ejection fraction (EF), both at rest (R) and during exercise (E). All patient received an initial dose of 10 mg/day of pegvisomant, then increased of 5 mg/day every 6 weeks on the basis of IGF-I levels until their normalization, or achievement of the maximal dose of 40 mg/day. At baseline, R-EF was normal in all patients whereas percent increase of EF after exercise was normal in 10 of the 12 (83.3%) patients. At the last follow-up, E-HR (130.7±17.4 vs 107.5±18.5 vs bpm, P=0.02), E-DBP (100.0±12.6 vs 86.2±4.3 mmHg, P=0.01) and E-PFR (3.98±1.42 vs 2.66±0.7 SV/s, P=0.01) were significantly reduced compared to baseline. No significant difference was found in E-SBP and E-PER. Moreover, although no significant difference was found in EF both at rest and after exercise, a significant improvement and normalization of the EF response to exercise was found in the two cases in which it was impaired at the study entry. Conversely, one patient showed a significant worsening of EF response to exercise. In conclusion, long-term treatment with pegvisomant improves cardiac performance, mainly ameliorating the response of heart rate and blood pressure to exercise.