January - March 2019, Volume 15, Issue 1

Natchev E, Kundurdjiev A, Zlatareva N, Vandeva V, Kirilov G, Kundurzhiev T, Zacharieva S

Echocardiographic Myocardial Changes in Acromegaly: a Cross-Sectional Analysis in a Tertiary Center in Bulgaria

Acta Endo (Buc) 2019, 15 (1): 52-61
doi: 10.4183/aeb.2019.52

Context. Cardiomyopathy is the most frequent cardiovascular complication in acromegaly. Objective. We aimed to compare some echocardiographic markers in acromegaly patients with controls and find a correlation with disease duration, disease activity, levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Design. We conducted a cross-sectional casecontrol study for the period of 2008-2012. Subjects and methods. Acromegaly patients altogether 146 (56 men and 90 women), were divided into four groups according to disease activity and the presence of arterial hypertension (AH). The control group included 83 subjects, matching the patient groups by age, gender and presence of AH. GH was measured by an immunofluorometric method, while IGF-1 by IRMA method. All patients and controls were subjected to one- and two-dimensional transthoracic echocardiography, color and pulse Doppler. Results. We found a thickening of the left ventricular walls and an increase in the left ventricular mass. However, these changes were not statistically significant in all groups and no correlation with disease duration could be demonstrated. As markers of diastolic dysfunction, increased deceleration time and isovolumetric relaxation were registered, which were dependent mainly on age in a binary logistic regression analysis, but not GH or IGF-1. Using absolute values, ejection and shortening fractions were increased in some groups. Using cut-off values, a higher percentage of systolic dysfunction was demonstrated in patients compared to their corresponding controls. Engagement of the right heart ventricle was also found – increased deceleration time and decreased e/a tric ratio. Conclusions. In conclusion, functional impairments of both ventricles were present, with a predominance of left ventricular diastolic dysfunction.

Keywords: acromegaly, acromegaly cardiomyopathy, echocardiography, GH, IGF-1.

Correspondence: Emil Natchev, MD, Medical University-Sofia, Department of Endocrinology, 2 “Zdrave” St., 1431 Sofia, Bulgaria, E-mail: enatchev@abv.bg