Prevalence and determinants of left ventricular hypertrophy in acromegaly: impact of different methods of indexing left ventricular mass.
BACKGROUND
Left ventricular hypertrophy (LVH) is the most common cardiac abnormality in acromegaly. Left ventricular mass (LVM) is an important parameter measured to detect LVH, but the relationship with body size should be considered by correcting LVM to body surface area (BSA), height or height2.7. All trials concerning acromegaly have detected LVH on the basis of LVM indexed for BSA, but have been criticized for disregarding the effects of obesity.


METHODS
97 patients with active acromegaly and a control group of 97 nonacromegalic subjects, were compared for the prevalence of LVH, calculated with different corrections of LVM for BSA, height and height2.7. In addition, we evaluated determinants of LVH in acromegalic group.


RESULTS
In controls, the prevalence of LVH, determined by correcting LVM for BSA (10.3%) was significantly lower than correcting by LVM/height (21.6%, P = 0.05) and LVM/height2.7 (33%, P < 0.0001). Similarly, in the acromegalic population the prevalence of LVH was significantly higher when measured by LVM/height (86.6%) or LVM/height2.7 (89.7%), than by LVM/BSA (67%) (P = 0.002 and P < 0.0001, respectively). A lower prevalence of LVH detected by LVM/BSA than LVM/height and LVM/height2.7 has been observed in an acromegalic overweight group, while in patients with normal weight there was no significant differences using different corrections. In acromegalic patients with disease duration of <or= 10 years the prevalence of LVH by correcting LVM for height2.7 was higher than when correcting for BSA. No difference in the prevalence of LVH determined by different corrections was observed in patients with disease duration > 10 years. By separate multiple regression analyses systolic blood pressure was the only independent determinant of LVM/BSA or LVM/height, while systolic blood pressure and GH levels were both predictors of LVM/height2.7.


CONCLUSIONS
LVM indexed for height2.7 appears to be the most appropriate method to identify LVH in acromegaly, particularly in overweight patients and those with shorter disease duration.
Department of Molecular Endocrinology, Federico II School of Medicine, University of Naples, Italy.
Giovanni
G
Vitale
Maurizio
M
Galderisi
Rosario
R
Pivonello
Letizia
L
Spinelli
Antonio
A
Ciccarelli
Oreste
O
de Divitiis
Gaetano
G
Lombardi
Annamaria
A
Colao
D000172:Acromegaly / Q000150:complications*; D000208:Acute Disease; D000328:Adult; D001827:Body Height; D015992:Body Mass Index; D001830:Body Surface Area; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D015995:Prevalence