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Improvement of intrinsic myocardial contractility and cardiac fibrosis degree in acromegalic patients treated with somatostatin analogues: a prospective study
Author(s) -
Bogazzi Fausto,
Di Bello Vitantonio,
Palagi Caterina,
Donne Maria Grazia Delle,
Di Cori Andrea,
Gavioli Silvia,
Talini Enrica,
Cosci Chiara,
Sardella Chiara,
Brogioni Sandra,
Mariani Mario,
Martino Enio
Publication year - 2005
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2005.02265.x
Subject(s) - acromegaly , medicine , contractility , ejection fraction , cardiology , myocardial fibrosis , diastole , endocrinology , prospective cohort study , somatostatin , fibrosis , heart failure , blood pressure , hormone , growth hormone
Summary Background Acromegalic patients have increased left ventricular (LV) mass (M) and impaired diastolic function. Aim 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. Patients and 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.