Endocrine Abstracts

Background: Despite the preserved left ventricular(LV) ejection fraction, patients with acromegaly are characterized by subclinical systolic dysfunction, i.e. abnormal global longitudinal strain(GLS) assessed by speckle-tracking echocardiography(STE). The effect of acromegaly treatment on LV systolic function assesed by STE has not been evaluated so far.

Patients and methods: Thirty two naïve acromegaly patients with no detectable heart disease were enrolled in a prospective, single-center study. 2D Echocardiography and STE GLS was performed at the diagnosis, 3 and 6 months on preoperative somatostatin receptor ligand(SRL) treatment and 3 months after the transsphenoidal surgery(TSS).

Results: Treatment with SRL resulted in a significant reduction in median GH& IGF-1 levels after 3 months from 9.1(3.2-21.9) ng/ml to 1.8(0.9-5.2) ng/ml(P<0.001) and from 3.2(2.3-4.3)xULN to 1.5(1.1-2.5)xULN(P<0.001), respectively. Longer SRL treatment did not lead to further decrease in GH& IGF-1 levels. Biochemical control on SRL was achieved in 25.8% and complete surgical remission was achieved in 41.7% of patients. TSS resulted in a decrease in IGF-1 compared to IGF-1 levels on SRL treatment: from 1.5(1.2-2.5)xULN to 1.3(1.0-1.6)xULN (P=0.003). Females had lower IGF-1 levels at baseline, on SRL and after TSS compared to males. The majority of patients had normal end diastolic and end systolic LV volumes(median LVEDV 56.4mL/m² in males and 44.5mL/m² in females, median LVESV 23.4mL/m² in males and 16.7mL/m² in females). Almost half of the patients(46.9%) had abnormal LVMi, however the median value of LVMi was normal in both sex groups: 99g/m² in males and 94g/m² in females. Most of the patients(78.1%) had abnormal LAVi and the median was 41.8mL/m². At baseline 50% of acromegaly patients had abnormal GLS, i.e. higher than -20% and the majority constituted men (62.5% vs. 37.5%). There was a positive correlation between baseline GLS and BMI r=0.446(P=0.011) and BSA r=0.411(P=0.019). GLS significantly improved after 3 months of SRL treatment compared to baseline: -20.4% vs. -20.0%(P=0.045). There was no further change in GLS after 6 months of SRL therapy and no significant change after TSS. The median GLS was significantly lower in patients with surgical remission compared to those who had elevated GH& IGF-1 levels: -22.5% vs. -19.8%(P=0.029). There was a positive correlation between GLS and IGF-1 levels after TSS r=0.570(P=0.007).

Conclusions: The greatest beneficial effect of acromegaly treatment on LV systolic function is visible already after 3 months of preoperative SRL treatment, especially in women. Patients with surgical remission have better systolic function as assessed by STE compared to patients with persistent acromegaly.