Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods

Abstract

Background: Acromegaly is a rare disease that requires modern treatment to decrease the risk of mortality, mainly from vascular diseases. Identifying acromegalic patients with increased cardiovascular risk is challenging. Speckle-tracking echocardiography (STE) is a modern, well-validated, and reproducible method of assessing left ventricular longitudinal deformation and providing a sensitive assessment of myocardial contractility. We hypothesized that STE may be useful in evaluating subclinical dysfunction of the left heart in acromegalic patients, especially when a left ventricle (LV) assessment is completed with STE of the left atrium (LA). Purpose: To assess the diagnostic value of speckle-tracking echocardiography in identifying the occurrence of LV and LA functional impairment in patients with acromegaly, in comparison to patients without this rare pituitary disease. Methods: Echocardiographic assessments of LV and LA function using the new STE method were performed in 60 subjects: 30 acromegalic (ACRO group) patients and a CONTROL group with 30 patients matched in terms of age, gender, systolic/diastolic pressure, and history of hypertension for at least 12 months. Results: The ACRO group, compared to the CONTROL group, presented: (1) higher left ventricular mass (left ventricular mass index: 132 vs. 108 g/m 2 , p < 0.001) and, in consequence, more frequent LV hypertrophy (80.0 vs. 53.3%; p = 0.028); (2) impaired LV systolic function measured by both left ventricular ejection fraction (LVEF) (63.4 vs. 66.9%, p < 0.001) and global longitudinal strain (GLS) (−18.1 vs. −19.4%, p = 0.023); (3) greater LA anteroposterior diameter (40.3 vs. 36.9 mm, p = 0.003) and indexed left atrial volume (37.9 vs. 27.6 ml/m 2 , p < 0.001); and (4) impaired echocardiographic strain parameters corresponding with LA function. Conclusions: Acromegaly, even in young patients with good blood pressure control, may be associated with left ventricular hypertrophy and subclinical impairment of the left ventricular and left atrial mechanical function, which may be identified by speckle-tracking echocardiography. Further research in this area is necessary to clarify the prognostic value of these phenomena.

Is treated hypopituitarism associated with increased left ventricular strains?—detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

“…Absence or reduced level of certain hormones could be theorized to be associated with changes in myocardial mechanics. Mostly acromegaly was investigated (3)(4)(5)(6)(7), but limited information is available with other endocrine diseases (8). Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a promising new validated imaging technique with capability of 3D volumetric and functional assessment of certain heart chambers (9)(10)(11)(12).…”

Echocardiographic assessment of cardiac function after mild coronavirus disease 2019: A preliminary report

“…The echocardiographic measurements were conducted accordingly to the current guidelines 7–9 . All measurements of the left ventricle (LV), left ventricular ejection fraction (LVEF), LV mass (LVM), LVM index (LVMI), LV hypertrophy (LVH) determination and diagnosis of LV diastolic dysfunction were made according to the methodology described in the authors' earlier study 10 …”

Advances in Research on the Cardiovascular Complications of Acromegaly

“…Compared with age-and sex-matched healthy controls, patients with acromegaly had significant subclinical systolic dysfunction (67). Similarly, Uziębło-Życzkowska et al recently compared 30 cases of acromegaly with 30 cases of a control group matched by sex, age, and blood pressure and found that the left ventricular systolic function of patients with acromegaly was significantly impaired, the GLS value was significantly reduced, and patients with acromegaly had higher left ventricular weight, larger left atrium anteroposterior diameter and left atrium volume index (69). However, Volschan et al evaluated the GLS of 37 patients with acromegaly and 48 controls (matched by sex, age, hypertension, and diabetes) and found no differences between patients and controls (66).…”

“…Similarly, Uziębło-Życzkowska et al. recently compared 30 cases of acromegaly with 30 cases of a control group matched by sex, age, and blood pressure and found that the left ventricular systolic function of patients with acromegaly was significantly impaired, the GLS value was significantly reduced, and patients with acromegaly had higher left ventricular weight, larger left atrium anteroposterior diameter and left atrium volume index ( 69 ). However, Volschan et al.…”

“…Since obvious impairment of systolic function is rare, some studies have attempted to evaluate the early damage of the myocardium in patients with acromegaly. At present, there are studies using speckle tracking echocardiography (STE) to study the early changes in the left ventricular systolic function of the heart in patients with acromegaly (66)(67)(68)(69). STE can analyze the local and overall systolic deformation capacity of the left ventricle, and its average value reflects the global longitudinal strain (GLS) of the left ventricular systolic function.…”