Improvement of intrinsic myocardial contractility and cardiac fibrosis degree in acromegalic patients treated with somatostatin analogues: a prospective study

• Published in: Clinical endocrinology (Oxford) Vol. 62; no. 5; pp. 590 - 596
• Main Authors: Bogazzi, Fausto, Di Bello, Vitantonio, Palagi, Caterina, Donne, Maria Grazia Delle, Di Cori, Andrea, Gavioli, Silvia, Talini, Enrica, Cosci, Chiara, Sardella, Chiara, Brogioni, Sandra, Mariani, Mario, Martino, Enio
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.05.2005; Blackwell; Wiley Subscription Services, Inc
• Subjects: Acromegaly - drug therapy; Acromegaly - etiology; Acromegaly - pathology; Adenoma - complications; Adenoma - surgery; Adult; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; Case-Control Studies; Echocardiography, Doppler; Endocrinopathies; Female; Fibrosis; Fundamental and applied biological sciences. Psychology; Growth Hormone - blood; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Insulin-Like Growth Factor I - analysis; Linear Models; Male; Medical sciences; Middle Aged; Myocardial Contraction - drug effects; Myocardium - pathology; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Octreotide - therapeutic use; Pituitary Neoplasms - complications; Pituitary Neoplasms - surgery; Prospective Studies; Remission Induction; Vertebrates: endocrinology; Endocrinopathy; Heart; Human; Myocardial fibrosis; Peptide hormone; Diseases of the osteoarticular system; Contractility; Acromegaly; Patient; Neuropeptide; Treatment; Pituitary diseases; Circulatory system; Somatostatin; Endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2005.02265.x

Summary Background Acromegalic patients have increased left ventricular (LV) mass (M) and impaired diastolic function. Aim Using ultrasonic cardiac tissue characterization, we evaluated the early changes in cardiac fibrosis (IBS) and intrinsic myocardial contractility (CVI) as well as their reversibility after treatment with somatostatin analogues (SMSA) in patients with acromegaly. Patients and Methods Twenty‐two acromegalic patients with active untreated disease (AcroUNTR) underwent conventional Doppler echocardiography and integrated backscattering; 25 healthy subjects (controls) and eight patients with acromegaly in remission after pituitary adenomectomy (AcroREM) served as controls. Results As expected, AcroUNTR at baseline had higher LVM than controls or AcroREM (P < 0·001); LVM reduced in acromegalic patients after SMSA (P < 0·005 vs. baseline) while LV ejection fraction did not change. LV diastolic function was reduced in all acromegalic patients, either at baseline or after SMSA therapy (E/A ratio, 0·96 ± 0·3 and 1·1 ± 0·3, respectively, P < 0·002 vs. controls, 1·6 ± 0·3). CVI was reduced in AcroUNTR (14·3 ± 5·8%, P < 0·003 vs. controls, 28·7 ± 7·5%) and greatly improved after SMSA (22·5 ± 4·5%, P < 0·003 vs. baseline). Cardiac fibrosis was increased in AcroUNTR (IBSMSI, 53·7 ± 5·3%P < 0·002 vs. controls) and reduced after SMSA (43·7 ± 4·2%P < 0·002 vs. baseline) albeit not reaching values observed in controls. More importantly, five of 22 (23%) AcroUNTR patients had normal LVM, but increased cardiac fibrosis as revealed by back scattering. IBS values and CVI% were related with serum GH and IGF‐1 (P < 0·0001) levels, and the estimated duration of disease (P < 0·005). Conclusions The present study demonstrated that active acromegalic patients had early impairment of systolic function and increased cardiac fibrosis; increased fibrosis may precede LV hypertrophy; these changes are related to the activity of disease and might improve during treatment with SMSA.