title: Treatment with growth hormone receptor antagonist in acromegaly: effect on cardiac structure and performance.
abstract: OBJECTIVE
  The aim of the current study was to evaluate the effect of short-term (6 months) and long-term (18 months) treatment with pegvisomant on cardiac structure and performance in patients with acromegaly.
  
  
  METHODS
  Seventeen patients (nine women, eight men, 27-61 yr) with active acromegaly entered and 12 completed the long-term study. After a baseline evaluation, including measurement of hemodynamic, biochemical, and hormonal parameters, and a standard Doppler echocardiography, treatment with pegvisomant was started at the initial dose of 10 mg/d, increasing by 5 mg/d every 6 wk on the basis of IGF-I levels until normalization or the achievement of a maximal dose of 40 mg/d.
  
  
  RESULTS
  After short-term treatment, IGF-I levels were normalized in 10 of the 17 (59%) patients. Left ventricular mass index (LVMi) was significantly decreased without changes in diastolic and systolic performance. After long-term treatment, IGF-I levels were normalized in 10 of the 12 (83%) patients. Blood glucose and serum insulin levels were decreased compared with baseline. LVMi was further decreased compared with short-term treatment, so that the prevalence of left ventricle hypertrophy decreased from 50% at baseline to 17% after 18 months of treatment. Moreover, ejection fraction as well as early to late (atrial) peak velocity ratio (E/A) were significantly increased, whereas isovolumic relaxation time was significantly decreased compared with baseline, demonstrating an improvement of both diastolic and systolic function. A significant correlation was found between the change in IGF-I levels and that of left ventricular ejection fraction. In general, the prevalence of cardiac insufficiency was present in 13 of the 17 (76%) patients at baseline and in one (8%) patient after 18 months of treatment.
  
  
  CONCLUSIONS
  Long-term treatment with the GH receptor antagonist improves acromegalic cardiomyopathy by decreasing cardiac hypertrophy and enhancing diastolic and systolic function, and consequently partially or completely reverting the cardiac insufficiency.
authors.affiliation: Department of Molecular and Clinical Endocrinology, Federico II University of Naples, via S. Pansini 5, 80131 Naples, Italy. rpivone@tin.it
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.forename: Renata S
authors.initials: RS
authors.lastname: Auriemma
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: De Martino
authors.forename: Mariano
authors.initials: M
authors.lastname: Galdiero
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciccarelli
authors.forename: Arcangelo
authors.initials: A
authors.lastname: D'Errico
authors.forename: Ione
authors.initials: I
authors.lastname: Kourides
authors.forename: Pia
authors.initials: P
authors.lastname: Burman
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lombardi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D003971:Diastole / Q000187:drug effects; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors*; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; C406545:pegvisomant