Reversibility of Cardiac Involvement in Acromegaly Patients After Surgery: 12-Month Follow-up Using Cardiovascular Magnetic Resonance

Abstract

Purpose: Cardiac comorbidity is one of the leading causes of death among acromegaly patients. We aimed to investigate the reversibility of acromegalic cardiac involvement after surgical treatment using the gold standard method, cardiovascular magnetic resonance, and to explore the effects of endocrine remission and gender on reversibility. Methods: In this single-center, prospective cohort study, fifty untreated acromegaly patients were enrolled. Comprehensive cardiac assessments were performed using a 3.0 T magnetic resonance scanner before and 3 and 12 months after transsphenoidal adenomectomy. Results: Preoperatively, left ventricular (LV) enlargement (13.0%), LV systolic dysfunction (6.5%), right ventricular (RV) enlargement (4.3%), RV systolic dysfunction (2.2%) and myocardial fibrosis (12.0%) were identified. On average, the LV and RV ejection fractions of acromegaly patients were higher than the healthy reference values. Male patients had thicker LV myocardia, wider ventricular diameters and more dilated pulmonary artery roots than female patients. After surgery, LV myocardial hypertrophy was reversed, the left atrium was remodeled, and ventricular systolic dysfunction recovered to normal. Cardiac alterations were detected early in the 3 rd postoperative month and persisted until the 12 th month. The interventricular septum was initially thickened in the 3 rd postoperative month and then recovered at the 12th month. Notable postoperative cardiac reversibility was observed in male patients but did not occur in all female patients. Patients achieving endocrine remission with normalized hormone levels had thinner LV myocardia than patients without normalized hormone levels. Conclusion: Our findings demonstrated that some of the cardiac involvement in acromegaly patients is reversible after surgical treatment which lowers hormone levels. Endocrine remission and gender significantly impacted postoperative cardiac reversibility.

Vascular anomalies in patients with growth hormone-secreting pituitary adenomas: illustrative case report and systematic review of the literature

“…As broadly described in the literature and implemented in the diagnostic workup and treatment concepts of acromegalic patients, systemic diseases affecting, among others, the cardiovascular system occur due to GH over-secretion [1]. To determine the causes of the pathological changes, some authors present subclinical changes in the vessels based on ultrasound diagnostics [6][7][8][9][10][11][12]. In addition to these risk factors for the course of anesthesia, the anatomic vascular variations of the internal carotid artery pose particular challenges to the neurosurgeon for intraoperative management.…”

“…Eleven studies [5][6][7][8][9][10][11][12][13][14][15] describe the development of cardiovascular risk factors caused by the increase in GH level and the remission of these cardiovascular risk factors after surgical resection of GH-producing pituitary adenoma and decreased GH concentration. Of these, seven authors [5][6][7][8][9][10][11] (Table 3) describe clinically measurable changes that can be determined using transthoracic echocardiography or laboratory chemical parameters. Five studies [5][6][7][8]10] dealt with deterioration of left ventricular function and hypertrophy of the left ventricle under elevated levels of GH and IGF-1 and improvement of these parameters post-resection.…”

“…Of these, seven authors [5][6][7][8][9][10][11] (Table 3) describe clinically measurable changes that can be determined using transthoracic echocardiography or laboratory chemical parameters. Five studies [5][6][7][8]10] dealt with deterioration of left ventricular function and hypertrophy of the left ventricle under elevated levels of GH and IGF-1 and improvement of these parameters post-resection. The impact on glucose metabolism was reported in four studies [5,7,10,11].…”

“…On the one hand, the increased release of growth hormone through a pleiotropic effect results in increased morbidity due to cardiovascular disorders (arterial hypertension, systolic/ diastolic dysfunction, valvulopathies, cardiac arrhythmias, cardiomyopathy, myocardial infarction), cerebrovascular (stroke), metabolic disorders (diabetes mellitus, impaired glucose tolerance, and dyslipidemia) and respiratory disorders (obstructive sleep apnea syndrome, macroglossia, airway obstruction) [5][6][7][8][9][10][11]. Vascular endothelial dysfunction can be detected at the subclinical level (flowmediated dilatation (FMD), carotid intima-media thickness, pulse-wave velocity, elastic modulus, epicardial adipose tissue thickness, the augmentation index [6,[12][13][14][15], as well.…”

Rare Metabolic and Endocrine Diseases with Cardiovascular Involvement: Insights from Cardiovascular Magnetic Resonance – A Review

“…In patients with acromegaly, dilatation of heart cavities, hypertrophy, and normal or reduced ejection fraction [123][124][125][126][127][128] are observed, while most of these changes are reversed with surgical treatment of the disease [124]. Interestingly, these changes are more pronounced in men than in women [125].…”