Renin-Angiotensin System Blockade Improves Cardiac Indices in Acromegaly Patients

Thomas, Julia; Dattani, Abhishek; Zemrak, Filip; Burchell, Thomas; Akker, Scott; Kaplan, Felicity; Khoo, Bernard; Aylwin, Simon; Grossman, Ashley; Davies, L. Ceri; Korbonits, Márta

doi:10.1055/s-0042-123710

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…Another reasons that could explain the normal median GLS result and normal median LVMi were possibly the good hypertension control and the cardioprotective effect of novel antihypertensive drugs which has been proven in many studies (27)(28)(29). In our study, in the group of 17 patients diagnosed with hypertension, 14 (82.3%) were treated with ACEI/ARB-the drugs that have the potential to reverse LVH.…”

Section: Discussionmentioning

confidence: 55%

Effects of acromegaly treatment on left ventricular systolic function assessed by speckle tracking echocardiography in relation to sex differences: results from a prospective single center study

Popielarz-Grygalewicz

Stelmachowska-Banaś

Raczkiewicz

et al. 2023

Front. Endocrinol.

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BackgroundDespite the preserved LVEF, 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 assessed by STE, has not been evaluated so far.Patients and methodsThirty-two naïve acromegalic patients without detectable heart disease were enrolled in a prospective, single-center study. 2D-Echocardiography and STE were performed at diagnosis, 3&6 months on preoperative somatostatin receptor ligand (SRL) treatment and 3 months after transsphenoidal surgery (TSS).ResultsTreatment with SRL resulted in reduction in median (IQR) GH&IGF-1 levels after 3 months, from 9.1(3.2-21.9) to 1.8(0.9-5.2) ng/mL (p<0.001) and from 3.2(2.3-4.3) to 1.5(1.1-2.5) xULN (p<0.001), respectively. Biochemical control on SRL was achieved in 25.8% of patients after 6 months and complete surgical remission was achieved in 41.7% of patients. TSS resulted in decrease in median (IQR) IGF-1 compared to IGF-1 levels on SRL treatment: from 1.5(1.2-2.5) 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 median end diastolic and end systolic left ventricle volumes were normal. Almost half of the patients (46.9%) had increased LVMi, however the median value of LVMi was normal in both sex groups: 99g/m2 in males and 94g/m2 in females. Most patients (78.1%) had increased LAVi and the median value was 41.8mL/m2. At baseline 50% of patients, mostly men (62.5% vs. 37.5%) had GLS values higher than -20%. There was a positive correlation between baseline GLS and BMI r=0.446 (p=0.011) and BSA r=0.411 (p=0.019). The median GLS significantly improved after 3 months of SRL treatment compared to baseline: -20.4% vs. -20.0% (p=0.045). The median GLS was lower in patients with surgical remission compared to patients with 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).ConclusionThe 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 GLS compared to patients with persistent acromegaly.

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Section: Discussionmentioning

confidence: 55%

Effects of acromegaly treatment on left ventricular systolic function assessed by speckle tracking echocardiography in relation to sex differences: results from a prospective single center study

Popielarz-Grygalewicz

Stelmachowska-Banaś

Raczkiewicz

et al. 2023

Front. Endocrinol.

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“…Other reports describe how the classic treatments of acromegaly, including surgical resection of the pituitary adenoma, somatostatin analogs and GH antagonists, and stereotactic radiosurgery or fractionated radiation, might improve cardiac function in the short term but probably have very little effect on long-term prognosis [23, 24]. Successful later case reports support the idea of the use of traditional heart failure therapy, which consists of ACEIs, angiotensin receptor blockers, β-blockers, aldosterone antagonists, and diuretics, to further improve cardiovascular function because GH/IGF-1 control alone is insufficient [25, 26]. Heart transplant is an option for end-stage heart failure [24, 27].…”

Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy improves heart failure in one patient with acromegaly-induced cardiomyopathy: a case report

Wang

Liu

et al. 2019

J Med Case Reports

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Background Congestive heart failure is rarely observed in patients with acromegaly. Excessive growth hormone secretion and elevation of insulin-like growth factor 1 contribute to pathological changes in myocyte growth and structure, cardiac contractility, vascular function, and in later stage may progress to cardiac dysfunction. Early recognition of the condition is paramount, though the insidious progression of the disease commonly results in late diagnosis. Current standard regimens of pharmacological therapy, surgical treatment, radiotherapy are designed to normalize serum levels of both insulin-like growth factor 1 and growth hormone. In patients with late-stage heart failure due to acromegalic cardiomyopathy, cardiac resynchronization therapy might be a desirable treatment to help cardiac synchronization, improve symptoms, and eventually reduce hospital admissions together with mortality rates. Case presentation We describe a case of a 49-year-old man with a history of acromegaly who presented to our hospital with a diagnosis of decompensated systolic heart failure. Serial electrocardiograms showed wide (160–200 ms) QRS duration with left bundle branch block. Echocardiography showed severe left ventricular dysfunction that simultaneously achieved a left ventricular ejection fraction of 16%. Surgical indication was rarely assessed by neurosurgeons. Given that the stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects, cardiac resynchronization therapy was performed. Owing to biventricular synchronization and holding back reverse remodeling, the patient’s symptoms were successfully alleviated, and he was discharged from the hospital. Conclusions Congestive heart failure is a rare complication in acromegaly-induced cardiomyopathy (occurs in only 3% of patients). Early diagnosis and treatment with curative drugs more than cardiovascular implantable electronic devices might lead to better surgical outcomes in this group of patients.

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“…74 Dlhodobá prognóza srdcového zlyhávania na podklade kardiomyopatie u pacientov s akromegáliou zostáva nepriaznivá; úmrtnosť je približne u 25 % po 1 roku a viac ako 35 % po 5 rokoch. 75…”

Section: šPecifi Cká Liečba Akromegálie a Jej Vplyv Na Kvs Komorbidityunclassified

(Cardiovascular complications in acromegaly)

Ságová¹,

Kantárová²,

Mokáň³

et al. 2022

Cor Vasa

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Akromegália je zriedkavé, chronické, progresívne ochorenie vznikajúce najčastejšie na podklade adenómu hypofýzy. V dôsledku dlhodobej elevácie rastového hormónu (RH) a inzulínu podobného rastového faktora 1 (IGF-1) pri tomto ochorení dochádza k rozvoju reumatologických, kardiovaskulárnych, pľúcnych a metabolických komplikácií. Kardiovaskulárne ochorenia sú hlavnou príčinou morbidity a mortality u pacientov s akromegáliou. Medzi kardiovaskulárne komplikácie akromegálie patrí artériová hypertenzia, kardiomyopatia, poruchy srdcového rytmu, chlopňové chyby ako aj endotelová dysfunkcia. Diagnóza akromegálie býva oneskorená aj niekoľko rokov v dôsledku pomalej progresie príznakov. Včasná diagnostika a liečba ochorenia je nevyhnutná na odvrátenie chronického kardiovaskulárneho poškodenia.

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Renin-Angiotensin System Blockade Improves Cardiac Indices in Acromegaly Patients

Cited by 11 publications

References 14 publications

Effects of acromegaly treatment on left ventricular systolic function assessed by speckle tracking echocardiography in relation to sex differences: results from a prospective single center study

Effects of acromegaly treatment on left ventricular systolic function assessed by speckle tracking echocardiography in relation to sex differences: results from a prospective single center study

Cardiac resynchronization therapy improves heart failure in one patient with acromegaly-induced cardiomyopathy: a case report

(Cardiovascular complications in acromegaly)

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