Introduction: Acromegalic heart disease is characterized by concentric left ventricular (LV) hypertrophy and impaired LV function. Speckle tracking echocardiography (STE) allows a non-invasive and reproducible study of myocardial strain, a marker of cardiac deformability and early ventricular systolic dysfunction.
Objectives: The aims of the study are: 1) evaluation of STE parameters in acromegalic patients at diagnosis and during the follow-up; 2) appraisal of the role of hypertension, diabetes or both on the STE parameters in acromegaly; 3) assessment of the impact of biochemical control and different treatments for acromegaly on global LV longitudinal strain (GLS) and other echocardiographic features.
Patients and methods: It was an historical-prospective study enrolling 111 acromegalics and 54 matched subjects with non-functioning pituitary adenoma used as controls. All subjects underwent clinical and biochemical evaluations and two-dimensional echocardiography using STE. LV mass index (LVMi), LV ejection fraction (LVEF), E/A ratio, and GLS were obtained. 53 patients were evaluated at diagnosis of acromegaly; 21 of them were also longitudinally reassessed after reaching disease control. 79 subjects were evaluated during the follow-up and classified according to treatment for acromegaly: adenomectomy (n=11), somatostatin analogs (SSA, n=43), Pegvisomant (Peg, n=16), SSA + Peg (n=9). 69/79 subjects appraised during the follow-up had complete control of acromegaly at the time of STE evaluation.
Results: At diagnosis, mean LVMi was increased and mean E/A ratio was decreased in acromegaly compared to controls (t test; P=0.03 and P=0.009, respectively). The mean GLS differed between acromegaly and control group at diagnosis (t-test; −18.12±0.43 vs. −19.55±0.35, P=0.01). The presence of hypertension, diabetes or both did not affect GLS at diagnosis of acromegaly (ANOVA, P=0.81). Any differences in LVMi, EF, E/A ratio, and GLS were observed during follow-up, either stratifying patients with biochemical disease control or the basis of the type of therapy. In the group of subjects evaluated longitudinally, GLS improved in 12 and worsened in nine after the achievement of disease control even if the mean GLS value did not significantly change (paired t test P=0.62).
Conclusions: Acromegalic patients are characterized by concentric LV hypertrophy and diastolic dysfunction at diagnosis. GLS study showed, for the first time, slight impairment of cardiac deformability in naive acromegalic patients that was not influenced by the presence of hypertension and diabetes. The therapies and the biochemical control of acromegaly do not seem to influence myocardial strain in acromegalic patients.
19 May 2018 - 22 May 2018