title: High output heart failure in patients with newly diagnosed acromegaly.
abstract: OBJECTIVE
  We sought to determine the prevalence and characteristics of heart failure in patients with newly diagnosed acromegaly.
  
  
  METHODS
  We assessed 102 consecutive patients who had acromegaly (44 men; age range, 22 to 71 years) for signs and symptoms of heart failure. We included a control group of 33 nonobese healthy subjects (13 men; age range, 26 to 70 years). Cardiac morphologic parameters, left ventricular mass index, ejection fraction, end-systolic wall stress, and cardiac index were measured by echocardiography. Endocrinological assessment was performed in all participants.
  
  
  RESULTS
  Of the 102 patients, 10 (10%) had overt heart failure at the time of diagnosis of acromegaly, 9 of whom were men (P <0.01). Patients with acromegaly and heart failure had an increased mean (+/- SD) left ventricular end-diastolic diameter (76 +/- 11 mm) compared with those without heart failure (53 +/- 6 mm, P <0.001) and control subjects (49 +/- 5 mm, P <0.001). Patients with heart failure had higher left ventricular mass index (230 +/- 56 g/m2 vs. 118 +/- 40 g/m(2), P <0.001) and end-systolic wall stress (237 +/- 79 x 10(3) dyn/cm2 vs. 111 +/- 42 x 10(3) dyn/cm2, P <0.001), but lower ejection fraction (42% +/- 17% vs. 66% +/- 9%, P <0.001), in comparison with patients without heart failure. The mean cardiac index was significantly higher in patients with heart failure (4.3 +/- 1.8 L/min-m2) than in those without heart failure (3.5 +/- 0.8 L/min-m2, P = 0.04) or in control subjects (3.1 +/- 0.6 L/min-m2, P = 0.002). Two factors were independently associated with heart failure in acromegalic patients: cardiac index (odds ratio [OR] per SD of 1.0 L/min-m2 = 16; 95% confidence interval [CI]: 1.8 to 135) and ejection fraction (OR per SD of 12% = 0.7; 95% CI: 0.6 to 0.9).
  
  
  CONCLUSIONS
  High output heart failure with a modest decline in ejection fraction is frequently detected at the time of diagnosis of acromegaly. Left ventricular hypertrophy in these patients is characterized by a dilated ventricle and an increased left ventricular mass that is primarily due to the enlarged chamber diameter.
authors.affiliation: Institute of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center for Serbia, Belgrade University School of Medicine, Belgrade, Yugoslavia.
authors.forename: Svetozar S
authors.initials: SS
authors.lastname: Damjanovic
authors.forename: Aleksandar N
authors.initials: AN
authors.lastname: Neskovic
authors.forename: Milan S
authors.initials: MS
authors.lastname: Petakov
authors.forename: Vera
authors.initials: V
authors.lastname: Popovic
authors.forename: Bosiljka
authors.initials: B
authors.lastname: Vujisic
authors.forename: Milan
authors.initials: M
authors.lastname: Petrovic
authors.forename: Marina
authors.initials: M
authors.lastname: Nikolic-Djurovic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Simic
authors.forename: Sandra
authors.initials: S
authors.lastname: Pekic
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinkovic
mesh_terms: D000172:Acromegaly / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015022:Yugoslavia / Q000453:epidemiology