Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance.
Acromegalic patients are considered to be exposed to a doubled mortality rate, mostly for cardiovascular diseases. This open prospective study was designed to evaluate whether the impairment of cardiac performance could be reversed by the long-term suppression of GH and insulin-like growth factor I (IGF-I) levels. Eighteen patients with active acromegaly were studied before and 5 yr after surgery, followed by sc octreotide in 11 patients. Disease control (GH levels < or =1 microg/L after glucose load or < or =2.5 microg/L after fasting, respectively, together with normalized IGF-I levels for age) was achieved in seven patients after surgery and in six patients after 0.3--0.6 mg/day sc octreotide. Five patients were not controlled during the 5-yr follow-up. Cardiac performance at rest and at peak exercise was assessed by equilibrium radionuclide angiography at study entry and 5 yr after surgery alone or plus octreotide. Thirty-six sex- and age-matched healthy subjects served as controls. At study entry, patients had a lower left ventricular ejection fraction (LVEF) at peak exercise and LVEF exercise-induced changes, exercise duration, and capacity than controls (P < 0.001). After 5 yr of treatment, a significant decrease of resting heart rate (P = 0.03) and a significant increase of LVEF at peak exercise (P = 0.003) was found in patients achieving disease control. LVEF response at peak exercise worsened in none of the patients with controlled disease and in three patients with uncontrolled disease (60%) (chi(2) = 5.5; P = 0.02). Diastolic filling, exercise duration, and workload did not significantly change during the 5-yr follow-up. No difference was found between patients controlled by surgery alone or by surgery plus octreotide. This 5-yr prospective study demonstrated that the LVEF response at peak exercise improved in all patients achieving disease control, while it was worsened in 60% of uncontrolled ones. These results strengthen the need of a stable suppression of GH and IGF-I hypersecretion to restore a normal cardiac performance in acromegaly.
Colao
A
A
Department of Molecular and Clinical Endocrinology, Federico II University of Naples, 80131 Naples, Italy. coloa@unina.it
Cuocolo
A
A
Marzullo
P
P
Nicolai
E
E
Ferone
D
D
Della Morte
A M
AM
Pivonello
R
R
Salvatore
M
M
Lombardi
G
G
D000172:Acromegaly / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006728:Hormones / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010807:Physical Endurance; D011446:Prospective Studies; D011875:Radionuclide Angiography; D013318:Stroke Volume; D013997:Time Factors
D006728:Hormones; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide