title: Improvement of intrinsic myocardial contractility and cardiac fibrosis degree in acromegalic patients treated with somatostatin analogues: a prospective study.
abstract: BACKGROUND
  Acromegalic patients have increased left ventricular (LV) mass (M) and impaired diastolic function.
  
  
  OBJECTIVE
  Using ultrasonic cardiac tissue characterization, we evaluated the early changes in cardiac fibrosis (IBS) and intrinsic myocardial contractility (CVI) as well as their reversibility after treatment with somatostatin analogues (SMSA) in patients with acromegaly.
  
  
  METHODS
  Twenty-two acromegalic patients with active untreated disease (Acro(UNTR)) underwent conventional Doppler echocardiography and integrated backscattering; 25 healthy subjects (controls) and eight patients with acromegaly in remission after pituitary adenomectomy (Acro(REM)) served as controls.
  
  
  RESULTS
  As expected, Acro(UNTR) at baseline had higher LVM than controls or Acro(REM) (P < 0.001); LVM reduced in acromegalic patients after SMSA (P < 0.005 vs. baseline) while LV ejection fraction did not change. LV diastolic function was reduced in all acromegalic patients, either at baseline or after SMSA therapy (E/A ratio, 0.96 +/- 0.3 and 1.1 +/- 0.3, respectively, P < 0.002 vs. controls, 1.6 +/- 0.3). CVI was reduced in Acro(UNTR) (14.3 +/- 5.8%, P < 0.003 vs. controls, 28.7 +/- 7.5%) and greatly improved after SMSA (22.5 +/- 4.5%, P < 0.003 vs. baseline). Cardiac fibrosis was increased in Acro(UNTR) (IBS(MSI), 53.7 +/- 5.3%P < 0.002 vs. controls) and reduced after SMSA (43.7 +/- 4.2%P < 0.002 vs. baseline) albeit not reaching values observed in controls. More importantly, five of 22 (23%) Acro(UNTR) patients had normal LVM, but increased cardiac fibrosis as revealed by back scattering. IBS values and CVI% were related with serum GH and IGF-1 (P < 0.0001) levels, and the estimated duration of disease (P < 0.005).
  
  
  CONCLUSIONS
  The present study demonstrated that active acromegalic patients had early impairment of systolic function and increased cardiac fibrosis; increased fibrosis may precede LV hypertrophy; these changes are related to the activity of disease and might improve during treatment with SMSA.
authors.affiliation: Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy. f.bogazzi@endoc.med.unipi.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Bogazzi
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello
authors.forename: Caterina
authors.initials: C
authors.lastname: Palagi
authors.forename: Maria Grazia Delle
authors.initials: MG
authors.lastname: Donne
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Cori
authors.forename: Silvia
authors.initials: S
authors.lastname: Gavioli
authors.forename: Enrica
authors.initials: E
authors.lastname: Talini
authors.forename: Chiara
authors.initials: C
authors.lastname: Cosci
authors.forename: Chiara
authors.initials: C
authors.lastname: Sardella
authors.forename: Sandra
authors.initials: S
authors.lastname: Brogioni
authors.forename: Mario
authors.initials: M
authors.lastname: Mariani
authors.forename: Enio
authors.initials: E
authors.lastname: Martino
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D000236:Adenoma / Q000150:complications / Q000601:surgery; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D005355:Fibrosis; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D009206:Myocardium / Q000473:pathology*; D015282:Octreotide / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery; D011446:Prospective Studies; D012074:Remission Induction
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D015282:Octreotide