Congestive heart failure in acromegaly: A review of 6 cases

Abstract

Background:Though cardiac involvement is common in acromegaly, overt congestive heart failure is uncommon.Materials and Methods:This is retrospective analysis of hospital record between 1996 and 2007. We analyzed records of 150 consecutive patients with acromegaly. We included the patients with acromegaly those who had overt congestive heart failure either at presentation or during the course of illness for the present analysis. The diagnosis of acromegaly and congestive cardiac failure were based on standard criteria.Results:Out of 150 patients with acromegaly, 6 patients had overt CHF (4.0%), of which 4 presented with the features of CHF and 2 developed during the course of illness. Three patients had hypertension and 1 had diabetes. Baseline echocardiography showed severe biventricular dysfunction and global hypokinesia in all. Angiography showed dilated hypokinetic left ventricle with normal coronaries in 3, it was confirmed at autopsy in 1. Three underwent trans-sphenoidal surgery, 1 received somatostatin analogue as primary treatment modality. Normalization of growth hormone and IGF-1 led to improvement in cardiac function in 1, 1 patient lost to follow up, and 4 died during the course of illness. In 1 patient, autopsy was performed and cardiac specimen revealed normal coronaries, concentric ventricular hypertrophy, and dilatation with myofibrolysis and interfascicular fibrosis.Conclusion:Prevalence of overt CHF is 4% in present series. Overt CHF carries poor prognosis and hence, this complication should be recognized at earliest, and medical management to normalized cardiac function should be given utmost priority.

Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation

“…In a study performed in India, six of 150 patients (4%) with acromegaly presented with overt CHF. The authors concluded that GH and IGF-1 were the causes of the myocardial hypertrophy, because the cardiac manifestations reversed after GH and IGF-1 levels were normalized [ 8 ].…”

Caso Clínico: Manejo Perioperatorio en Pacientes con Acromegalia

“…Recordemos que la principal causa de morbimortalidad a nivel cardiovascular en este grupo de pacientes es por efecto del exceso circulante de GH; ya que provoca hipertrofia de ventrículo izquierdo, disfunción sistólica y diastólica, enfermedad valvular y cardiopatía isquémica [10]. La monitorización de rutina como electrocardiograma, frecuencia cardíaca, saturación de oxígeno, dióxido de carbono tidal final y monitoreo de presión arterial no invasivo al momento de la inducción nos puede dar información de los cambios hemodinámicos y ventilatorios.…”

Cardiovascular Effects of Excess Growth Hormone: How Real is the Threat?

“…According to a retrospective study by Khan et al [51] on the prevalence of comorbidities in patients with acromegaly, while many studies reported arrhythmias, none of the patients in their own study had a rhythm disorder [61]. In a case series by Dutta et al [61] on acromegaly with overt congestive HF, 50% of the patients died from ventricular arrhythmias, attributed to abnormal ventricular remodeling. Another case study by Subramnaian et al [62] illustrated that idiopathic premature ventricular contraction (PVC) and ventricular tachycardia (VT) can be manifestations of any systemic disease, including acromegaly.…”

“…Mortality in acromegaly may be attributed to arrhythmias and sudden cardiac death [59], although not much is known as of writing since these aspects of CVD are less studied in acromegaly [60]. According to a retrospective study by Khan et al [51] on the prevalence of comorbidities in patients with acromegaly, while many studies reported arrhythmias, none of the patients in their own study had a rhythm disorder [61]. In a case series by Dutta et al [61] on acromegaly with overt congestive HF, 50% of the patients died from ventricular arrhythmias, attributed to abnormal ventricular remodeling.…”

“…According to a retrospective study by Khan et al . [ 51 ] on the prevalence of comorbidities in patients with acromegaly, while many studies reported arrhythmias, none of the patients in their own study had a rhythm disorder [ 61 ]. In a case series by Dutta et al .…”