Two-dimensional speckle tracking echocardiography demonstrates no effect of active acromegaly on left ventricular strain

Volschan, Isabela; Kasuki, Leandro; Silva, C. M. S.; Alcantara, Mônica Luiza de; Saraiva, Roberto Magalhães; Xavier, Sérgio Salles

doi:10.1007/s11102-017-0795-9

Cited by 23 publications

(30 citation statements)

References 57 publications

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“…In our study, acromegalic patients had GLS slightly below normal value and it was statistically significant different in comparison to the control group. Different results of GLS in acromegalic patients were reached by Volschan et al [ 36 ]. Because studied groups in both trials were not homogenous, hard conclusions cannot be drawn.…”

Section: Discussionmentioning

confidence: 99%

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Popielarz-Grygalewicz

Gąsior

Konwicka

et al. 2018

International Journal of Endocrinology

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To determine whether the echocardiographic presentation allows for diagnosis of acromegalic cardiomyopathy. 140 patients with acromegaly underwent echocardiography as part of routine diagnostics. The results were compared with the control group comprising of 52 age- and sex-matched healthy volunteers. Patients with acromegaly presented with higher BMI, prevalence of arterial hypertension, and glucose metabolism disorders (i.e., diabetes and/or prediabetes). In patients with acromegaly, the following findings were detected: increased left atrial volume index, increased interventricular septum thickness, increased posterior wall thickness, and increased left ventricular mass index, accompanied by reduced diastolic function measured by the following parameters: E'med., E/E', and E/A. Additionally, they presented with abnormal right ventricular systolic pressure. All patients had normal systolic function measured by ejection fraction. However, the values of global longitudinal strain were slightly lower in patients than in the control group; the difference was statistically significant. There were no statistically significant differences in the size of the right and left ventricle, thickness of the right ventricular free wall, and indexed diameter of the ascending aorta between patients with acromegaly and healthy volunteers. None of 140 patients presented systolic dysfunction, which is the last phase of the so-called acromegalic cardiomyopathy. Some abnormal echocardiographic parameters found in acromegalic patients may be caused by concomitant diseases and not elevated levels of GH or IGF-1 alone. The potential role of demographic parameters like age, sex, and/or BMI requires further research.

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Section: Discussionmentioning

confidence: 99%

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Popielarz-Grygalewicz

Gąsior

Konwicka

et al. 2018

International Journal of Endocrinology

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“…Evident systolic dysfunction seems to be uncommon in ACRO [22,23], but Di Bello et al reported an impaired myocardial strain in ACRO (strain indicates the end-systolic and end-diastolic difference of myocardial fiber length), which could indicate a subclinical systolic dysfunction [24]. On the other hand, these results were not confirmed by Volschan et al, who did not reveal strain impairment [25]. The end stage of acromegaly cardiomyopathy is characterized by ventricular dilatation with systolic dysfunction [26,27].…”

Section: Introductionmentioning

confidence: 95%

Acromegaly and ultrasound: how, when and why?

Parolin

Dassiè

Vettor

et al. 2019

J Endocrinol Invest

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Background Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease. Purpose This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger. Conclusions Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.

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“…It is quite difficult to explain the differences in the results obtained without precise data about the stage of the disease. Maybe this is the reason for the differences; in our study, the GH median in the ACRO group was 12.7 vs. 8.64 ng/mL in Volschan et al (24).…”

Section: Left Ventricle Morphology and Functionmentioning

confidence: 45%

“…Di Bello et al (23) found that the acromegalic heart showed impaired LV systolic function assessed by systolic strain and systolic strain rate. However, a study by Volschan et al (24), which evaluated left ventricular longitudinal strain in 37 acromegalic patients compared to 48 controls, did not show impaired LV systolic function assessed by GLS. It is quite difficult to explain the differences in the results obtained without precise data about the stage of the disease.…”

Section: Left Ventricle Morphology and Functionmentioning

confidence: 90%

Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods

et al. 2020

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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.

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Two-dimensional speckle tracking echocardiography demonstrates no effect of active acromegaly on left ventricular strain

Cited by 23 publications

References 57 publications

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Acromegaly and ultrasound: how, when and why?

Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods

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