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Acromegaly is a rare disease and our knowledge of acromegalic cardiomyopathy is moderate.1 It is, however, very important for cardiologists to know that cardiovascular disease accounts for more than 50% of all deaths in acromegaly. Typical findings in acromegalic cardiomyopathy that should alert us include concentric left ventricular (LV) hypertrophy and progressive systolic dysfunction. These patients also suffer from hypertension, coronary artery disease, arrhythmias and valvular disease.2 The other most common cardiovascular risk factors in these patients are diabetes mellitus and sleep apnea syndrome. It is therefore clear that these patients will need cardiological expertise in addition to support from endocrinologists. Studies of myocardial function in acromegalic cardiomyopathy are welcome in order to increase our knowledge base, and the study by Kormányos et al. published in this issue of the Journal adds to our understanding of this disease, but it also raise some questions that merit a closer look.3 Their main findings were LV hypertrophy and impaired LV diastolic function with preserved LV systolic dysfunction. LV systolic function was assessed by ejection fraction (EF) and different strain measures. Radial strain was enhanced compared to normals, while longitudinal and circumferential strains were similar to those in normal individuals. The apparently divergent messages from their strain measures -enhanced radial thickening and normal

How to interpret assessment of left ventricular function by strain in acromegaly?