title: High prevalence of cardiac hypertophy without detectable signs of fibrosis in patients with untreated active acromegaly: an in vivo study using magnetic resonance imaging.
abstract: OBJECTIVE
  Left ventricular (LV) hypertrophy and myocardial fibrosis are considered the main pathological features of acromegalic cardiomyopathy. The aim of the study was to evaluate the proportion of LV hypertrophy and the presence of fibrosis in acromegalic cardiomyopathy in vivo using cardiac magnetic resonance (CMR).
  
  
  METHODS
  Fourteen consecutive patients (eight women, mean age 46 +/- 10 years) with untreated active acromegaly were submitted to two-dimensional (2D) colour Doppler and integrated backscatter (IBS) echocardiography and CMR.
  
  
  METHODS
  LV volume, mass and wall thickness and myocardial tissue characterization (IBS and CMR).
  
  
  RESULTS
  On echocardiography: mean LV mass (LVM) and LVM index (LVMi) were 209 +/- 48 g and 110 +/- 24 g/m(2), respectively; hypertrophy was revealed in five patients (36%); abnormal diastolic function [evaluated by isovolumic relaxation time (IVRT) or early (E) to late or atrial (A) peak velocities (E/A ratio)] was found in four patients (29%). Systolic function evaluated by measuring LV ejection fraction (LVEF) was normal (mean 72 +/- 12%) in all patients. Six patients (43%) had increased IBS (mean 57.4 +/- 6.2%). On CMR: mean LVM and LVMi were 151 +/- 17 g and 76 +/- 9 g/m(2), respectively; 10 patients (72%) had LV hypertrophy. Contrastographic delayed hyperenhancement was absent in all patients; on the contrary, mild enhancement was revealed in one patient. Systolic function was normal in all patients (LVEF 67 +/- 11%). LVMi was not related to serum IGF-1 concentrations or the estimated duration of disease.
  
  
  CONCLUSIONS
  CMR is considered to be the gold standard for evaluating cardiac hypertrophy, fibrosis and systolic function. Using CMR, 72% patients with untreated active acromegaly had LV hypertrophy, which was only detected in 36% patients by echocardiography. However, cardiac fibrosis was absent in all patients irrespective of the estimated duration of disease. Although a very small increase in collagen content (as suggested by increased cardiac reflectivity at IBS), not detectable by CMR, could not be ruled out, it is unlikely that it would significantly affect cardiac function.
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: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Strata
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aquaro
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello
authors.forename: Chiara
authors.initials: C
authors.lastname: Cosci
authors.forename: Chiara
authors.initials: C
authors.lastname: Sardella
authors.forename: Enrica
authors.initials: E
authors.lastname: Talini
authors.forename: Enio
authors.initials: E
authors.lastname: Martino
mesh_terms: D000172:Acromegaly / Q000150:complications*; D000328:Adult; D006332:Cardiomegaly / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D015150:Echocardiography, Doppler; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence