Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide.
BACKGROUND
Cardiovascular disease is the most frequent cause of death of patients with acromegaly.


OBJECTIVE
To investigate whether young patients with a presumed short disease duration are more likely to reverse the acromegalic cardiomyopathy than older patients with longer disease duration.


METHODS
An open prospective design.


METHODS
Ten young (aged < 40 years), and 12 middle-aged (41-59 years) patients with active acromegaly well controlled after 12 months of treatment with the depot formulation of octreotide (OCT-LAR); 22 sex- and age-matched healthy subjects as controls.


METHODS
Left ventricular (LV) mass (LVM) by echocardiography and performance by equilibrium radionuclide angiography were measured before and after 12 months of OCT-LAR treatment.


RESULTS
At study entry, none of the controls and 14 patients (63.4%) of whom six were young (chi2 = 17.7; P < 0.0001) had LV hypertrophy (LVH); none of the controls and four patients of whom one was young had insufficient LV ejection fraction (LVEF) at rest (< 50%); one control and 13 patients (59.1%) of whom five were young (chi2 = 12.7; P < 0.0001) had inadequate LVEF at peak exercise (deltaLVEF; < 5% increase of baseline). After 12 months, no change in haemodynamic and diastolic parameters was observed in both groups, except for a significant decrease in heart rate at peak exercise in young patients (P < 0.0001). The LVM index decreased significantly in both young (124.4 +/- 5.8 vs. 103.4 +/- 3.9 g/m2; P = 0.01) and middle-aged patients (140.9 +/- 7.9 vs. 117.8 +/- 6.6 g/m2; P = 0.03). LVH disappeared in 10 of 14 patients (71.4%): all six young and four of eight middle-aged patients (50%). LVEF at rest and at peak exercise increased significantly in both groups but deltaLVEF increased significantly only in young patients (1.5 +/- 2.9 vs. 13.7 +/- 5.2%, P = 0.04); it normalized in nine of 13 patients (69.2%), four of five young (80%) and four of eight middle-aged patients (50%). Exercise capacity (82.5 +/- 5.3 vs. 110.0 +/- 5.5 W, P = 0.005) and duration (7.3 +/- 0.3 vs. 9.9 +/- 0.4 min, P = 0.0003) also increased only in young patients.


CONCLUSIONS
The acromegalic cardiomyopathy is reversed in most young patients with short disease duration and achieving disease control after OCT-LAR treatment for 12 months, indicating that early diagnosis and effective treatment are essential.
Colao
Annamaria
A
Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Napoli, Italy. colao@unina.it
Marzullo
Paolo
P
Cuocolo
Alberto
A
Spinelli
Letizia
L
Pivonello
Rosario
R
Bonaduce
Domenico
D
Salvatore
Marco
M
Lombardi
Gaetano
G
D000172:Acromegaly / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D000328:Adult; D000367:Age Factors; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003692:Delayed-Action Preparations; D004452:Echocardiography; D018619:Echocardiography, Doppler, Pulsed; D005080:Exercise Test; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D015592:Immunoradiometric Assay; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D011446:Prospective Studies; D011875:Radionuclide Angiography; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D015282:Octreotide