1
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Schweizer JROL, Nachtigall LB. Cardiac MRI in acromegaly: looking for a big heart. Pituitary 2024; 27:317-319. [PMID: 38940858 DOI: 10.1007/s11102-024-01417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Affiliation(s)
| | - Lisa B Nachtigall
- Neuroendocrine and Pituitary Tumor Clinical Center, Massachusetts General Hospital, 100 Blossom Street Cox 140, Boston, MA, 02467, USA.
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2
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De Alcubierre D, Feola T, Cozzolino A, Pofi R, Galea N, Catalano C, Auriemma RS, Pirchio R, Pivonello R, Isidori AM, Giannetta E. The spectrum of cardiac abnormalities in patients with acromegaly: results from a case-control cardiac magnetic resonance study. Pituitary 2024; 27:416-427. [PMID: 38847918 PMCID: PMC11289141 DOI: 10.1007/s11102-024-01403-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Cardiac abnormalities are common in patients with acromegaly, contributing to the increased morbidity and mortality. Cardiac magnetic resonance (CMR) is the gold standard for measuring cardiac morpho-functional changes. This study aims to detect cardiac alterations in acromegaly through CMR, even when the disease is adequately controlled. METHODS In this, multicentre, case-control study, we compared consecutive patients with acromegaly, cured after surgery or requiring medical treatment, with matched controls recruited among patients harbouring non-functioning adrenal incidentalomas. RESULTS We included 20 patients with acromegaly (7 females, mean age 50 years) and 17 controls. Indexed left ventricular-end-diastolic volume (LV-EDVi) and LV-end-systolic volume (LV-ESVi) were higher in patients than in controls (p < 0.001), as were left ventricular mass (LVMi) (p = 0.001) and LV-stroke volume (LV-SVi) (p = 0.028). Right ventricle (RV) EDVi and ESVi were higher, whereas RV-ejection fraction (RV-EF) was lower (p = 0.002) in patients than in controls (p < 0.001). No significant differences were observed in the prevalence of cardiometabolic comorbidities, including hypertension, glucose and lipid metabolism impairment, obstructive sleep apnoea syndrome, and obesity. IGF1 x upper limit of normal significantly predicted LVMi (b = 0.575; p = 0.008). Subgroup analysis showed higher LVMi (p = 0.025) and interventricular septum thickness (p = 0.003) in male than female patients, even after adjusting cardiac parameters for confounding factors. CONCLUSIONS The CMR analysis reveals a cluster of biventricular structural and functional impairment in acromegaly, even when the biochemical control if achieved. These findings appear specifically triggered by the exposure to GH-IGF1 excess and show sex-related differences advocating a possible interaction with sex hormones in cardiac disease progression.
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Affiliation(s)
- Dario De Alcubierre
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Alessia Cozzolino
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy
| | - Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Nicola Galea
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Renata Simona Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Rosa Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy.
- Centre for Rare Diseases (ENDO-ERN accredited), Policlinico Umberto I, Rome, Italy.
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy.
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Nemes A, Rácz G, Kormányos Á, Gyenes N, Ambrus N, Lengyel C, Valkusz Z. Three-Dimensional Speckle-Tracking Echocardiography-Derived Tricuspid Annular Properties in Acromegaly-Results from the MAGYAR-Path Study. Biomedicines 2024; 12:1464. [PMID: 39062037 PMCID: PMC11274697 DOI: 10.3390/biomedicines12071464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Acromegaly is an endocrine pathology characterized by the overproduction of human growth hormone. The present study aimed to analyze three-dimensional speckle-tracking echocardiography (3DSTE)-derived tricuspid annular (TA) properties in detail in patients with acromegaly and to compare the findings to those of matched healthy controls. METHODS The present study consisted of 29 patients with acromegaly (mean age: 55.9 ± 14.5 years, 21 males), of which 13 had an active disease. The control population comprised 57 healthy subjects (mean age: 53.2 ± 8.4 years, 38 males). RESULTS In the presence of acromegaly, left atrial and end-diastolic left ventricular (LV) sizes were dilated, and LV ejection fraction was increased, which was accompanied by thickened interventricular septum and LV posterior wall as compared with matched healthy controls. The presence of grade 1 mitral (MR) and tricuspid (TR) regurgitations were more frequent in acromegaly than in controls, regardless of disease activity. Higher than grade 1 MR/TR was uncommon in acromegaly. The 3DSTE-derived all end-diastolic (2.47 ± 0.27 cm vs. 2.23 ± 0.27 cm; 8.73 ± 1.77 cm2 vs. 6.67 ± 1.40 cm2; 11.56 ± 1.34 cm vs. 10.20 ± 1.10 cm, p < 0.001 for all) and end-systolic (1.97 ± 0.27 cm vs. 1.77 ± 0.28 cm; 6.24 ± 1.61 cm2 vs. 5.01 ± 1.42 cm2; 9.80 ± 1.35 cm vs. 8.72 ± 1.10 cm, p < 0.001 for all) TA diameters, areas, and perimeters proved to be dilated, while TA functional parameters including TA fractional area change (28.77 ± 9.80% vs. 27.64 ± 15.34%, p = 0.720) and fractional shortening (20.60 ± 9.08% vs. 20.51 ± 8.81%, p = 0.822) were normal in acromegaly regardless of whether acromegaly was active or not. RA volumes respecting the cardiac cycle were dilated in acromegaly as compared with those of healthy controls regardless of disease activity and were associated with respective changes in TA dimensions. CONCLUSIONS In the presented acromegaly patients, significant TA dilation with preserved function could be detected regardless of disease activity. RA volumes and TA dimensions are correlated in acromegaly.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Gergely Rácz
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Árpád Kormányos
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Nándor Gyenes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Nóra Ambrus
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Zsuzsanna Valkusz
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
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4
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Nemes A, Kormányos Á, Ambrus N, Lengyel C, Valkusz Z. Myocardial, Valvular, and Vascular Structural and Functional Properties in Acromegaly. J Clin Med 2023; 12:6857. [PMID: 37959322 PMCID: PMC10648583 DOI: 10.3390/jcm12216857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Acromegaly is an uncommon systematic endocrine disease caused by the hypersecretion of human growth hormone and, consequently, of insulin-like growth factor-1 during adulthood. Acromegaly could cause a typical cardiomyopathy characterized by left ventricular hypertrophy associated with diastolic dysfunction, which later could progress to systolic dysfunction. Moreover, some valvular and vascular abnormalities are also associated with acromegaly. This present review aims to summarize available information regarding acromegaly-associated abnormalities in myocardial, valvular, and vascular structural and functional properties and their relationship to disease activity and treatment options.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, 6725 Szeged, Hungary; (Á.K.); (N.A.); (C.L.); (Z.V.)
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Rocha P, Barroso J, Carlos F, Muxfeldt E, Gadelha M, Kasuki L. Importance of 24 h ambulatory blood pressure monitoring in patients with acromegaly and correlation with cardiac magnetic resonance findings. Pituitary 2023:10.1007/s11102-023-01321-8. [PMID: 37247075 DOI: 10.1007/s11102-023-01321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Arterial hypertension (AH) is prevalent in acromegaly, but few studies using 24-h ambulatory blood pressure monitoring (24 h-ABPM) suggest that its frequency may be different from office blood pressure (OBP). Left ventricular hypertrophy (LVH) is one of the most frequent cardiac abnormalities. Cardiac magnetic resonance (CMR) is considered the gold standard to evaluate the heart. OBJECTIVES To compare the frequency of AH when measured by 24 h-ABPM and by OBP and to correlate BP with cardiac mass. METHODS Patients over 18 years of age with acromegaly underwent OBP evaluation and were later referred to the 24 h-ABPM. Treatment-naïve patients were submitted to CMR. RESULTS We evaluated 96 patients. From 29 non hypertensive patients by OBP, 9 had AH on 24 h-ABPM. In the group of patients with a previous diagnosis of AH by OBP, 25 had controlled BP and 42 had abnormal BP on 24 h-ABPM, when analyzed by OBP there were 28 with controlled BP. We observed a positive correlation between diastolic BP measured in 24 h-ABPM and IGF-I levels, but we did not observe the same correlation with age, sex, body mass index and GH levels. The CMR was performed in 11 patients. We found a positive correlation of left ventricular mass (LVM) and BP of 24 h-ABPM. In contrast, there was no correlation of OBP with CMR parameters. CONCLUSIONS We observed, that 24 h-ABPM in acromegaly allows the diagnosis of AH in some patients with normal BP in OBP and also to allow a better treatment. 24 h-ABPM shows a better correlation with VM by CMR.
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Affiliation(s)
- Paula Rocha
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Fernanda Carlos
- Resistant Hypertension Program (ProHArt-HUCFF), Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Elizabeth Muxfeldt
- Resistant Hypertension Program (ProHArt-HUCFF), Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Medical School - Rio de Janeiro, Universidade Estácio de Sá, Campus Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brazil
| | - Monica Gadelha
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil.
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° Andar, Setor 9F, Sala de Pesquisa em Neuroendocrinologia, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil.
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6
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Ságová I, Dragula M, Mokáň M, Vaňuga P. Filling the gap between the heart and the body in acromegaly: a case-control study. Endocrine 2023; 79:365-375. [PMID: 36309947 PMCID: PMC9892104 DOI: 10.1007/s12020-022-03232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters. PURPOSE The aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters. METHODS We prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry. RESULTS Acromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly patients was 67% (78% concentric, 22% eccentric). IGF -1 levels, BMI, and lean mass positively correlated with LVM in all acromegaly patients (P < 0.001). Fat mass positively correlated with LVM in females (R = 0.306, P = 0.005), but this correlation was not found in males. We did not find any difference in size of the left and right ventricle between acromegaly patients and controls. Acromegaly patients presented with left atrium enlargement, diastolic dysfunction and low incidence of systolic dysfunction. Valvopathy was found in 43% of patients with predominant (31%) prevalence of mitral regurgitation. CONCLUSION Our study demonstrates higher prevalence of cardiovascular comorbidities in acromegaly patients and the impact of IGF-1 levels and body composition parameters in pathology in some of these comorbidities.
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Affiliation(s)
- Ivana Ságová
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia.
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia.
| | - Milan Dragula
- Cardiology clinic University Hospital Martin, Martin, Slovakia
| | - Marián Mokáň
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Peter Vaňuga
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
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7
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Shoaib MA, Chuah JH, Ali R, Hasikin K, Khalil A, Hum YC, Tee YK, Dhanalakshmi S, Lai KW. An Overview of Deep Learning Methods for Left Ventricle Segmentation. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2023; 2023:4208231. [PMID: 36756163 PMCID: PMC9902166 DOI: 10.1155/2023/4208231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/25/2022] [Accepted: 11/24/2022] [Indexed: 01/31/2023]
Abstract
Cardiac health diseases are one of the key causes of death around the globe. The number of heart patients has considerably increased during the pandemic. Therefore, it is crucial to assess and analyze the medical and cardiac images. Deep learning architectures, specifically convolutional neural networks have profoundly become the primary choice for the assessment of cardiac medical images. The left ventricle is a vital part of the cardiovascular system where the boundary and size perform a significant role in the evaluation of cardiac function. Due to automatic segmentation and good promising results, the left ventricle segmentation using deep learning has attracted a lot of attention. This article presents a critical review of deep learning methods used for the left ventricle segmentation from frequently used imaging modalities including magnetic resonance images, ultrasound, and computer tomography. This study also demonstrates the details of the network architecture, software, and hardware used for training along with publicly available cardiac image datasets and self-prepared dataset details incorporated. The summary of the evaluation matrices with results used by different researchers is also presented in this study. Finally, all this information is summarized and comprehended in order to assist the readers to understand the motivation and methodology of various deep learning models, as well as exploring potential solutions to future challenges in LV segmentation.
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Affiliation(s)
- Muhammad Ali Shoaib
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Information and Communication Technology, BUITEMS, Quetta, Pakistan
| | - Joon Huang Chuah
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Raza Ali
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Information and Communication Technology, BUITEMS, Quetta, Pakistan
| | - Khairunnisa Hasikin
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Azira Khalil
- Faculty of Science & Technology, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Yan Chai Hum
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Malaysia
| | - Yee Kai Tee
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Malaysia
| | - Samiappan Dhanalakshmi
- Department of Electronics and Communication Engineering, SRM Institute of Science and Technology, Kattankulathur, India
| | - Khin Wee Lai
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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8
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Role of cardiovascular magnetic resonance in the clinical evaluation of left ventricular hypertrophy: a 360° panorama. Int J Cardiovasc Imaging 2022; 39:793-809. [PMID: 36543912 DOI: 10.1007/s10554-022-02774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Left ventricular hypertrophy (LVH) is a frequent imaging finding in the general population. In order to identify the precise etiology, a comprehensive diagnostic approach should be adopted, including the prevalence of each entity that may cause LVH, family history, clinical, electrocardiographic and imaging findings. By providing a detailed evaluation of the myocardium, cardiovascular magnetic resonance (CMR) has assumed a central role in the differential diagnosis of left ventricular hypertrophy, with the technique of parametric imaging allowing more refined tissue characterization. This article aims to establish a parallel between pathophysiological features and imaging findings through the broad spectrum of LVH entities, emphasizing the role of CMR in the differential diagnosis.
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9
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Sendur SN, Hazirolan T, Aydin B, Lay I, Alikasifoglu M, Erbas T. Specific FSTL1 polymorphism may determine the risk of cardiomyopathy in patients with acromegaly. Acta Cardiol 2022; 77:350-359. [PMID: 34233581 DOI: 10.1080/00015385.2021.1948206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We have investigated the role of a cardiomyokine, follistatin-like 1 (FSTL1), and its single nucleotide polymorphism on acromegalic cardiomyopathy. METHODS The study was performed as a cross-sectional case research in a Tertiary Referral Centre. Forty-six patients with acromegaly (29 F-17 M, mean age: 50.3 ± 12.1 years) were included. FSTL1 levels were measured and the rs1259293 region of the FSTL1 gene was subjected to polymorphism analysis. 1.5 Tesla MRI was used to obtain cardiac images. RESULTS There were 15 active (6 F-9M) and 31 (22 F-9M) controlled patients. Active patients had a higher left ventricular mass (LVM) and left ventricular mass index (LVMi). GH levels were positively correlated with left ventricular end-diastolic volume index (LVEDVi), stroke volume index (SVi), cardiac index (Ci), LVM and LVMi; r = 0.35, 0.38, 0.34, 0.39 and 0.39, respectively. IGF-1 index was positively correlated with LVEDVi, left ventricular end-systolic volume index (LVESVi), SVi, Ci, LVM and LVMi; r = 0.36, 0.34, 0.32, 0.31, 0.42 and 0.42, respectively. Twenty out of 46 patients with acromegaly (43.5%) had myocardial fibrosis. FSTL1 levels were neither correlated with disease activity nor with any functional and structural cardiac parameter. Multivariate linear regression analysis revealed no association between FSTL1 and any study parameters. The rs1259293 variant genotype CC was significantly associated with low left ventricular mass. CONCLUSIONS Serum FSTL1 levels are not associated with functional and structural measures of myocardium in patients with acromegaly. However, the risk of left ventricular hypertrophy is reduced in CC genotyped individuals of FSTL1.
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Affiliation(s)
- Suleyman Nahit Sendur
- Department of Endocrinology & Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Busra Aydin
- Department of Medical Genetics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Incilay Lay
- Department of Medical Biochemistry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Alikasifoglu
- Department of Medical Genetics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tomris Erbas
- Department of Endocrinology & Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
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Christidi A, Mavrogeni SI. Rare Metabolic and Endocrine Diseases with Cardiovascular Involvement: Insights from Cardiovascular Magnetic Resonance - A Review. Horm Metab Res 2022; 54:339-353. [PMID: 35526533 DOI: 10.1055/a-1846-4878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Abstract
The identification of rare diseases with cardiovascular involvement poses significant diagnostic challenges due to the rarity of the diseases, but also due to the lack of knowledge and expertise. Most of them remain underrecognized and undiagnosed, leading to clinical mismanagement and affecting the patients' prognosis, as these diseases are per definition life-threatening or chronic debilitating. This article reviews the cardiovascular involvement of the most well-known rare metabolic and endocrine diseases and their diagnostic approach through the lens of cardiovascular magnetic resonance (CMR) imaging and its prognostic role, highlighting its fundamental value compared to other imaging modalities.
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Affiliation(s)
- Aikaterini Christidi
- Cardiovascular Magnetic Resonance, Euromedica General Clinic, Thessaloniki, Greece
| | - Sophie I Mavrogeni
- Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece, Exercise Physiology and Sport Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, Athens, Greece
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11
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(Cardiovascular complications in acromegaly). COR ET VASA 2022. [DOI: 10.33678/cor.2021.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Ragonese M, Di Bella G, Spagnolo F, Grasso L, Alibrandi A, Giuffrida G, Moleti M, Ferraù F, Cannavò S. Serum NT-pro-BNP Levels Predict Cardiovascular Events in Acromegaly
Patients. Exp Clin Endocrinol Diabetes 2021; 130:229-236. [PMID: 34942671 PMCID: PMC9072124 DOI: 10.1055/a-1540-5009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background
Acromegaly is associated with an increased risk of fatal and
non-fatal cardiovascular (CV) events. Controlling acromegaly decreases, but does
not normalize this risk. Brain natriuretic peptide (BNP) assessment is used in
the general population for the diagnosis of heart failure and to predict
ischemic recurrences and mortality. This is a retrospective, longitudinal,
monocenter study that evaluates the role of serum N-terminal fragment of BNP
(NT-pro-BNP) for predicting CV events in acromegaly patients.
Methods
Serum NT-pro-BNP levels were measured in 76 patients with
acromegaly (23 males, 57.7±1.5 years), and compared with other
predictors of CV events. NT-pro-BNP cut-off value discriminating the occurrence
of CV events was determined by ROC analysis. CV events were recorded during a
follow-up of 78.6±6.4 months.
Results
CV events occurred in 9.2% of patients. Mean
log(NT-pro-BNP) concentration was higher in patients who experienced CV events
than in those who did not (p<0.01) and in patients who died due to CV
events than in those who died due to other causes (p<0.01). Based on the
ROC curve, a cut-off value of 91.55 pg/mL could predict CV
events (OR 19.06). Log(NT-pro-BNP) was lower in surgically treated patients by
surgery (p<0.05), and in those cured by neurosurgery
(p<0.02).
Conclusions
High NT-pro-BNP value is an independent middle-term predictor
of fatal or non-fatal CV events in patients with acromegaly. According to this
parameter, surgically treated patients show lower CV risk than those managed
with medical therapy, especially if the disease is cured.
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Affiliation(s)
- Marta Ragonese
- Department of Human Pathology DETEV, University of Messina, Messina,
Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of
Messina, Messina, Italy
| | | | - Loredana Grasso
- Service of Immunometry and Laboratory Diagnosis, University Hospital
“G. Martino”, Messina, Italy
| | | | - Guiseppe Giuffrida
- Department of Clinical and Experimental Medicine, University of
Messina, Messina, Italy
| | - Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of
Messina, Messina, Italy
| | - Francesco Ferraù
- Department of Human Pathology DETEV, University of Messina, Messina,
Italy
| | - Salvatore Cannavò
- Department of Human Pathology DETEV, University of Messina, Messina,
Italy
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13
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Hinojosa-Amaya JM, Varlamov EV, Yedinak CG, Cetas JS, McCartney S, Banskota S, Fleseriu M. Echocardiographic findings in acromegaly: prevalence of concentric left ventricular remodeling in a large single-center cohort. J Endocrinol Invest 2021; 44:2665-2674. [PMID: 33893617 DOI: 10.1007/s40618-021-01579-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Acromegaly is a rare disease and is associated with increased cardiovascular (CV) morbidity and mortality, especially in patients with uncontrolled disease. We aimed to analyze the prevalence and severity of cardiomyopathy and valvular heart disease in a large cohort of patients with a confirmed acromegaly diagnosis, at baseline and after treatment. METHODS We retrospectively reviewed an institutional approved database; 190 patients with confirmed acromegaly and follow-up data available (years 2006-2018). Patients with at least one baseline echocardiogram, were included. Demographic, disease control and echocardiogram variables were collected for analysis. RESULTS Of the 190 patients 110 (58%) had a baseline echocardiogram and 43 (39.1%) had at least one follow-up echocardiogram after surgical, medical or multimodal treatment. Baseline left ventricular hypertrophy (LVH) prevalence was 17.8% (64.7% concentric; 35.3% eccentric), diastolic and systolic dysfunction, and overt cardiomyopathy with heart failure were 15.8, 7.9, and 3.0%, respectively. Concentric remodeling of the left ventricle (LV) was noted in 31.4% of patients without LVH. Valve defects were found in 87.3% of patients (14.6% with significant valvular heart disease). CONCLUSION Early diagnosis of acromegaly and disease control should be attempted to prevent LVH/LV dysfunction and development of valvular heart disease. Concentric LV remodeling develops prior to obvious LV hypertrophy in almost a third of patients with acromegaly, which is a novel finding. Similar to other epidemiological studies, we found a high prevalence of LVH/LV dysfunction. Although possible, reversal of systolic and diastolic dysfunction is sporadic after treatment of acromegaly.
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Affiliation(s)
- J M Hinojosa-Amaya
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonóma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - E V Varlamov
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Department of Medicine (Endocrinology, Diabetes and Clinical Nutrition), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - C G Yedinak
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - J S Cetas
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Operative Care Division, Portland Veterans Administration Hospital, 3710 SW US Veterans Hospital Road, Portland, OR, USA
| | - S McCartney
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - S Banskota
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA
| | - M Fleseriu
- Department of Neurological Surgery, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA.
- Department of Medicine (Endocrinology, Diabetes and Clinical Nutrition), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA.
- Pituitary Center, Oregon Health & Science University, Mail Code CH8N, 3303 South Bond Ave, Portland, OR, 97239, USA.
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Young JA, Buchman M, Duran-Ortiz S, Kruse C, Bell S, Kopchick JJ, Berryman DE, List EO. Transcriptome profiling of insulin sensitive tissues from GH deficient mice following GH treatment. Pituitary 2021; 24:384-399. [PMID: 33433889 PMCID: PMC8122029 DOI: 10.1007/s11102-020-01118-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Most studies that have examined the transcriptional response to GH have been performed with a single tissue. Thus, the current study performed RNASeq across three insulin-sensitive tissues of GH-treated GH deficient (GHKO) mice. METHODS GHKO mice were injected with recombinant human GH (hGH) or vehicle daily for 5 days and adipose, liver, and muscle tissues were collected 4 h after the final injection. RNA was isolated from the tissues and sequenced. Genes that were differentially expressed between GH and vehicle treatments were further analyzed. Enrichment analysis and topology-aware pathway analysis were performed. RESULTS GHKO mice treated with hGH had expected phenotypic alterations, with increased body, fat, fluid, liver, and muscle mass, and increased serum IGF-1 and insulin. 55 Genes were differentially expressed in all three tissues, including the canonical GH targets Igf1, Igfals, and Cish. Enrichment analysis confirmed the canonical GH response in select tissues, such as cell proliferation, metabolism, and fibrosis. The JAK/STAT pathway was the only pathway significantly altered in all three tissues. CONCLUSIONS As expected, GH caused expression changes of many known target genes, although new candidate GH targets were identified. Liver and muscle appear to be more GH sensitive than adipose tissue due to the larger number of DEG and pathways significantly altered, but adipose still has a characteristic GH response. The diversity of changes uncovered in all three tissues after 5 days of GH treatment highlights the multiplicity of GH's effects in its target tissues.
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Affiliation(s)
- Jonathan A. Young
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Mat Buchman
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
| | | | - Colin Kruse
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
| | - Stephen Bell
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
| | - John J. Kopchick
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Darlene E. Berryman
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
- The Diabetes Institute at Ohio University, Ohio University, Athens, OH 45701, USA
- Indicates co-senior authors. Please send correspondence to Edward O. List, Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA.
| | - Edward O. List
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
- Indicates co-senior authors. Please send correspondence to Edward O. List, Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA.
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15
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Yang H, Tan H, Huang H, Li J. Advances in Research on the Cardiovascular Complications of Acromegaly. Front Oncol 2021; 11:640999. [PMID: 33869029 PMCID: PMC8050332 DOI: 10.3389/fonc.2021.640999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular-related complications are one of the most common complications in patients with acromegaly, and can lead to an increased risk of death. Hypertension and cardiomyopathy are the main cardiovascular complications. The characteristics of acromegalic cardiomyopathy are concentric biventricular hypertrophy and diastolic dysfunction. In addition, arrhythmia and heart valve disease are common cardiac complications in acromegaly. Although the underlying pathophysiology has not been fully elucidated, the spontaneous overproduction of GH and IGF-1, increasing age, prolonged duration of disease and the coexistence of other cardiovascular risk factors are crucial to cardiac complications in patients with acromegaly. Early diagnosis and appropriate treatment of acromegaly might be beneficial for the prevention of cardiomyopathy and premature death.
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Affiliation(s)
- Han Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Department of Endocrinology and Metabolism, Chongqing Sixth People’s Hospital, Chongqing, China
| | - Huiwen Tan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianwei Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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16
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Dereli S, Özer H, Özer N, Bayramoğlu A, Kaya A. Association between fragmented QRS and left ventricular dysfunction in acromegaly patients. Acta Cardiol 2020; 75:435-441. [PMID: 31079588 DOI: 10.1080/00015385.2019.1610835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In acromegaly patients; it has been observed that heart failure may develop even in the absence of predisposing factors such as hypertension, diabetes mellitus, so a specific acromegalic cardiomyopathy has been suggested. We aimed to evaluate the fQRS frequency in acromegaly patients and the left ventricular (LV) functions of acromegaly patients with fQRS.Methods: Our study included 60 acromegalic patients. Each patient underwent conventional echocardiography and tissue Doppler imaging. The patients included were separated into two groups: those with (n:23) and without (n:37) fQRS.Results: Significant differences were identified between fQRS(+) and fQRS (-) groups with respect to disease duration (p < .001), Left ventricular end diastolic volume (EDV) (p < .001), E velocity (p < .001), E\A ratio (p < .001), E' velocity (p < .001), E/E' ratio (p < .001), isovolumic relaxation time (IVRT) (p < .001), MPI (p < .001). Disease duration (odds ratio [OR]: 2.120 (1.023-1.703 95% confidence interval [CI]), p = .002), E' (OR:3.029 (1.013-1.703 95% CI) p = .004) and fQRS (OR:4.59 (1.94-10.87 95% CI), p = .001) were identified as the independent predictors of myocardial performance index (MPI). However, disease duration (OR:1.078 (1.030-1.128 95% CI), p = .001), E/E' (OR: 1.43 (1.22-1.97 95% CI), p = .001), IVRT (OR:1.65 (1.32-2.06 95% CI), p = .001) and MPI (OR:1.014 (1.004-1.024 95% CI), p = .002) were the independent predictors of fQRS.Conclusions: fQRS was frequent and an independent predictor of MPI that was independelty associated with LV dysfunction in patients with acromegaly. In light of these findings the presence of fQRS is thought to be an indicator of acromegalic CMP development.
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Affiliation(s)
- Seçkin Dereli
- Deparment of Cardiology, Ordu State Hospital, Ordu, Turkey
| | - Hatice Özer
- Deparment of Endocrinology, Ordu State Hospital, Ordu, Turkey
| | - Nurtaç Özer
- Deparment of Cardiology, Ordu State Hospital, Ordu, Turkey
| | - Adil Bayramoğlu
- Deparment of Cardiology, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Ahmet Kaya
- Deparment of Cardiology, Ordu University Faculty of Medicine, Ordu, Turkey
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17
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Kasuki L, Antunes X, Lamback EB, Gadelha MR. Acromegaly: Update on Management and Long-Term Morbidities. Endocrinol Metab Clin North Am 2020; 49:475-486. [PMID: 32741483 DOI: 10.1016/j.ecl.2020.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acromegaly is a systemic disease associated with great morbidity and increased mortality if not adequately treated. In the past decades much improvement has been achieved in its treatment and in the knowledge of its comorbidities. We provide an update of acromegaly management with current recommendations. We also address long-term comorbidities emphasizing the changing face of the disease in more recent series, with a decrease of cardiovascular disease severity and an increased awareness of comorbidities like bone disease, manifested mainly as vertebral fractures and the change in the main cause of death (from cardiovascular disease to cancer in more recent series).
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Affiliation(s)
- Leandro Kasuki
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil; Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, 156th Resende Street, Rio de Janeiro, RJ, Brazil; Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Ximene Antunes
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil
| | - Elisa Baranski Lamback
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil
| | - Mônica R Gadelha
- Endocrinology Division, Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9, Ilha do Fundão, Rio de Janeiro 21941-913, Brazil; Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, 156th Resende Street, Rio de Janeiro, RJ, Brazil; Neuropatology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
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Abstract
PURPOSE OF THE REVIEW The aim of this review was to discuss the role of cardiac magnetic resonance (CMR) for the prognostic stratification of cardiomyopathies, highlighting strengths and limitations. RECENT FINDINGS CMR is considered as a diagnostic pillar in the management of non-ischemic cardiomyopathies. Over the last years, attention has shifted from CMR's diagnostic capability towards prognostication in the various settings of cardiomyopathies. CMR is considered the gold standard imaging technique for the evaluation of ventricular volumes and systolic function as well as providing non-invasive virtual-histology by means of specific myocardial tissue characterization pulse sequences. CMR is an additive tool to risk stratifying patients and to identify those that require strict monitoring and more aggressive treatment.
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19
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Kormányos Á, Domsik P, Kalapos A, Gyenes N, Valkusz Z, Lengyel C, Forster T, Nemes A. Active acromegaly is associated with enhanced left ventricular contractility: Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Kormányos Á, Domsik P, Kalapos A, Gyenes N, Valkusz Z, Lengyel C, Forster T, Nemes A. Active acromegaly is associated with enhanced left ventricular contractility: Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study. Rev Port Cardiol 2020; 39:189-196. [DOI: 10.1016/j.repc.2019.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022] Open
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21
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Kormányos Á, Kalapos A, Domsik P, Gyenes N, Ambrus N, Valkusz Z, Lengyel C, Nemes A. The right atrium in acromegaly-a three-dimensional speckle-tracking echocardiographic analysis from the MAGYAR-Path Study. Quant Imaging Med Surg 2020; 10:646-656. [PMID: 32269925 PMCID: PMC7136732 DOI: 10.21037/qims.2020.02.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/23/2020] [Indexed: 08/06/2023]
Abstract
BACKGROUND Acromegaly is a chronic, rare hormonal disease associated with major cardiovascular co-morbidities. The disease, in the majority of the cases, is caused by a benign human growth hormone (hGH) secreting adenoma. Cardiovascular involvement is especially common in acromegalic patients from the most common hypertension to cardiomyopathy. Left ventricular hypertrophy and myocardial fibrosis are considered common findings in acromegalic cardiomyopathy, which might result in severe heart failure at end-stages. It was set out to quantify right atrial (RA) morphology and function in a group of acromegalic patients using three-dimensional (3D) speckle-tracking echocardiography (3DSTE). METHODS The study comprised 30 patients from which 8 patients were excluded due to inadequate image quality. Mean age of the remaining acromegaly patients were 53.7±14.5 years (7 males). In the control group 44 healthy adults were enrolled (mean age: 50.7±12.6 years, 15 males). In each case, complete two-dimensional Doppler echocardiography was performed followed by 3DSTE. RESULTS All three RA volumetric parameters (Vmax, Vmin, VpreA) were significantly higher in case of acromegaly compared to the healthy controls. Strain analysis revealed that RA function may be enhanced in acromegalic patients, which is more notable in case of active acromegaly. Numerous independent strain parameters had significant correlations with different hormonal variables in the active acromegaly group. These correlations were not present in the inactive acromegaly subgroup. CONCLUSIONS Acromegaly has a profound effect on RA function and with proper treatment these changes partly seem to be reversible.
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Affiliation(s)
- Árpád Kormányos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nándor Gyenes
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nóra Ambrus
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Valkusz
- 1st Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- 1st Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Guo X, Cao J, Liu P, Cao Y, Li X, Gao L, Wang Z, Fang L, Jin Z, Wang Y, Xing B. Cardiac Abnormalities in Acromegaly Patients: A Cardiac Magnetic Resonance Study. Int J Endocrinol 2020; 2020:2018464. [PMID: 32148485 PMCID: PMC7042537 DOI: 10.1155/2020/2018464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/24/2019] [Accepted: 01/09/2020] [Indexed: 12/21/2022] Open
Abstract
Cardiac abnormalities are the most common and deadly comorbidities of acromegaly. Assessments using cardiac magnetic resonance (CMR) imaging in acromegaly patients are rare. We aimed to evaluate the frequencies of left ventricular hypertrophy (LVH), interventricular septum hypertrophy (IVSH), LV systolic dysfunction (LVSD), right ventricular systolic dysfunction (RVSD), and myocardial fibrosis (MCF) and detailed quantitative parameters in acromegaly patients using CMR and analyze their correlations with clinical features. Sixty-one patients were enrolled in this study. The rates of LVH, IVSH, LVSD, RVSD, and MCF were 26.2%, 27.9%, 8.2%, 9.8%, and 14.8%, respectively. The average LV mass, LV mass index, IVS thickness, LV and RV free wall thickness, and LV and RV ejection fractions were 114.4 g, 60.0 g/m2, 9.6 mm, 7.2 mm, 2.9 mm, 59.9%, and 56.6%, respectively. The LV mass index was larger (68.9 ± 26.0 vs. 48.8 ± 10.6 g/m2), the IVS was thicker (10.3 ± 2.8 vs. 8.8 ± 1.8 mm), and the LV (57.6 ± 12.3% vs. 62.8 ± 4.8%) and RV ejection fractions (54.6 ± 8.7% vs. 59.2 ± 5.9%) were lower in male patients than in female patients (all p < 0.05). Age, body mass index (BMI), disease duration, and hypertension were associated with cardiac abnormalities (all p < 0.05). In conclusion, structural and functional cardiac abnormalities can be comprehensively evaluated by CMR in acromegaly patients. Gender greatly affects the presence of cardiac abnormalities. Age, BMI, disease duration, and hypertension but not GH or IGF-1 levels are associated clinical factors.
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Affiliation(s)
- Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Beijing 100730, China
- China Pituitary Adenoma Specialist Council, Beijing 100730, China
| | - Jian Cao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Peijun Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Beijing 100730, China
- China Pituitary Adenoma Specialist Council, Beijing 100730, China
| | - Zihao Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Beijing 100730, China
- China Pituitary Adenoma Specialist Council, Beijing 100730, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- China Pituitary Disease Registry Center, Beijing 100730, China
- China Pituitary Adenoma Specialist Council, Beijing 100730, China
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Guo X, Cao Y, Cao J, Li X, Liu P, Wang Z, Gao L, Bao X, Xing B, Wang Y. Reversibility of Cardiac Involvement in Acromegaly Patients After Surgery: 12-Month Follow-up Using Cardiovascular Magnetic Resonance. Front Endocrinol (Lausanne) 2020; 11:598948. [PMID: 33193111 PMCID: PMC7609918 DOI: 10.3389/fendo.2020.598948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/02/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Cardiac comorbidity is one of the leading causes of death among acromegaly patients. We aimed to investigate the reversibility of acromegalic cardiac involvement after surgical treatment using the gold standard method, cardiovascular magnetic resonance, and to explore the effects of endocrine remission and gender on reversibility. METHODS In this single-center, prospective cohort study, fifty untreated acromegaly patients were enrolled. Comprehensive cardiac assessments were performed using a 3.0 T magnetic resonance scanner before and 3 and 12 months after transsphenoidal adenomectomy. RESULTS Preoperatively, left ventricular (LV) enlargement (13.0%), LV systolic dysfunction (6.5%), right ventricular (RV) enlargement (4.3%), RV systolic dysfunction (2.2%) and myocardial fibrosis (12.0%) were identified. On average, the LV and RV ejection fractions of acromegaly patients were higher than the healthy reference values. Male patients had thicker LV myocardia, wider ventricular diameters and more dilated pulmonary artery roots than female patients. After surgery, LV myocardial hypertrophy was reversed, the left atrium was remodeled, and ventricular systolic dysfunction recovered to normal. Cardiac alterations were detected early in the 3rd postoperative month and persisted until the 12th month. The interventricular septum was initially thickened in the 3rd postoperative month and then recovered at the 12th month. Notable postoperative cardiac reversibility was observed in male patients but did not occur in all female patients. Patients achieving endocrine remission with normalized hormone levels had thinner LV myocardia than patients without normalized hormone levels. CONCLUSION Our findings demonstrated that some of the cardiac involvement in acromegaly patients is reversible after surgical treatment which lowers hormone levels. Endocrine remission and gender significantly impacted postoperative cardiac reversibility.
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Affiliation(s)
- Xiaopeng Guo
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Yihan Cao
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Cao
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Li
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peijun Liu
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zihao Wang
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Lu Gao
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Xinjie Bao
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Bing Xing
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
- *Correspondence: Bing Xing, ; Yining Wang,
| | - Yining Wang
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Bing Xing, ; Yining Wang,
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Dörr K, Kammer M, Reindl-Schwaighofer R, Lorenz M, Loewe C, Marculescu R, Erben R, Oberbauer R. Effect of etelcalcetide on cardiac hypertrophy in hemodialysis patients: a randomized controlled trial (ETECAR-HD). Trials 2019; 20:601. [PMID: 31651370 PMCID: PMC6813957 DOI: 10.1186/s13063-019-3707-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/06/2019] [Indexed: 02/15/2023] Open
Abstract
Background Fibroblast growth factor 23 (FGF23) is associated with left ventricular hypertrophy (LVH) in patients with chronic kidney disease, and calcimimetic therapy reduces plasma concentrations of FGF23. It remains unknown whether treatment with the calcimimetic etelcalcetide (ETL) reduces LVH in patients on hemodialysis. Methods/design This single-blinded randomized trial of 12 months duration will test the effects of ETL compared with alfacalcidol on LVH and cardiac fibrosis in maintenance hemodialysis patients with secondary hyperparathyroidism. Both treatment regimens will be titrated to equally suppress secondary hyperparathyroidism while alfacalcidol treatment causes an increase and ETL a decrease in FGF23, respectively. Patients treated thrice weekly with hemodialysis for ≥ 3 months and ≤ 3 years with parathyroid hormone levels ≥ 300 pg/ml and LVH will be enrolled in the study. The primary study endpoint is change from baseline to 12 months in left ventricular mass index (LVMI; g/m2) measured by cardiac magnetic resonance imaging. Sample size calculations showed that 62 randomized patients will be necessary to detect a difference in LVMI of at least 20 g/m2 between the two groups at 12 months. Due to the strong association of volume overload and LVH, randomization will be stratified by residual kidney function, and regular body composition monitoring will be performed to control the volume status of patients. Study medication will be administered intravenously by the dialysis nurses after every hemodialysis session, thus omitting adherence issues. Secondary study endpoints are cardiac parameters measured by echocardiography, biomarker concentrations of bone metabolism (FGF23, vitamin D, parathyroid hormone, calcium, phosphate, s-Klotho), cardiac markers (pro-brain natriuretic peptide, pre- and postdialysis troponin T) and metabolites of the renin–angiotensin–aldosterone cascade (angiotensin I (Ang I), Ang II, Ang-(1–7), Ang-(1–5), Ang-(1–9), and aldosterone). Discussion The causal inference and pathophysiology of LVH regression by FGF23 reduction using calcimimetic treatment has not yet been shown. This intervention study has the potential to discover a new strategy for the treatment of cardiac hypertrophy and fibrosis in patients on maintenance hemodialysis. It might be speculated that successful treatment of cardiac morphology will also reduce the risk of cardiac death in this population. Trial registration European Clinical Trials Database, EudraCT number 2017-000222-35; ClinicalTrials.gov, NCT03182699. Registered on
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Affiliation(s)
- Katharina Dörr
- Department of Nephrology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Kammer
- Department of Nephrology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.,Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Clinical Biometrics, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | | | - Matthias Lorenz
- Vienna Dialysis Center, Kapellenweg 37, 1220, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Intervention, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rodrig Marculescu
- Laboratory Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Reinhold Erben
- Physiology, Pathophysiology, and Experimental Endocrinology, VetMed Vienna, Veterinärplatz 1, Vienna, Austria
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Abstract
In patients with acromegaly, chronic GH and IGF-I excess commonly causes a specific cardiomyopathy characterized by a concentric cardiac hypertrophy associated with diastolic dysfunction and, in later stages, with systolic dysfunction ending in heart failure in untreated and uncontrolled patients. Additional relevant cardiovascular complications are represented by arterial hypertension, valvulopathies, arrhythmias, and vascular endothelial dysfunction, which, together with the respiratory and metabolic complications, contribute to the development of cardiac disease and the increase cardiovascular risk in acromegaly. Disease duration plays a pivotal role in the determination of acromegalic cardiomyopathy. The main functional disturbance in acromegalic cardiomyopathy is the diastolic dysfunction, observed in 11% to 58% of patients, it is usually mild, without clinical consequence, and the progression to systolic dysfunction is generally uncommon, not seen or observed in less than 3% of the patients. Consequently, the presence of overt CHF is rare in acromegaly, ranging between 1 and 4%, in patients with untreated and uncontrolled disease. Control of acromegaly, induced by either pituitary surgery or medical therapy improves cardiac structure and performance, limiting the progression of acromegaly cardiomyopathy to CHF. However, when CHF is associated with dilative cardiomyopathy, it is generally not reversible, despite the treatment of the acromegaly.
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Affiliation(s)
- Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University Federico II, Naples, Italy.
| | - Ludovica F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University Federico II, Naples, Italy
| | | | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University Federico II, Naples, Italy
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García-Álvarez M, Climent V. Sleep apnea and cardiovascular complications of the acromegaly. Response to the medical treatment. MINERVA ENDOCRINOL 2019; 44:159-168. [DOI: 10.23736/s0391-1977.18.02930-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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Natchev E, Kundurdjiev A, Zlatareva N, Vandeva S, Kirilov G, Kundurzhiev T, Zacharieva S. ECHOCARDIOGRAPHIC MYOCARDIAL CHANGES IN ACROMEGALY: A CROSS-SECTIONAL ANALYSIS IN A TERTIARY CENTER IN BULGARIA. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; -5:52-61. [PMID: 31149060 DOI: 10.4183/aeb.2019.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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 case-control 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.
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Affiliation(s)
- E Natchev
- Medical University of Sofia, Faculty of Medicine, Department of Endocrinology, Sofia, Bulgaria
| | - A Kundurdjiev
- Medical University of Sofia, University Hospital "St. Iv. Rilski", Sofia, Bulgaria
| | - N Zlatareva
- Acibadem City Clinic Cardiovascular Center, Cardiology, Sofia, Bulgaria
| | - S Vandeva
- Medical University of Sofia, Faculty of Medicine, Department of Endocrinology, Sofia, Bulgaria
| | - G Kirilov
- Medical University of Sofia, Faculty of Medicine, Department of Endocrinology, Sofia, Bulgaria
| | - T Kundurzhiev
- Medical University of Sofia, Faculty of Public Health, Sofia, Bulgaria
| | - S Zacharieva
- Medical University of Sofia, Faculty of Medicine, Department of Endocrinology, Sofia, Bulgaria
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Ramos-Leví AM, Marazuela M. Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them? Front Endocrinol (Lausanne) 2019; 10:120. [PMID: 30930848 PMCID: PMC6423916 DOI: 10.3389/fendo.2019.00120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.
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Householder LA, Comisford R, Duran-Ortiz S, Lee K, Troike K, Wilson C, Jara A, Harberson M, List EO, Kopchick JJ, Berryman DE. Increased fibrosis: A novel means by which GH influences white adipose tissue function. Growth Horm IGF Res 2018; 39:45-53. [PMID: 29279183 PMCID: PMC5858978 DOI: 10.1016/j.ghir.2017.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE White adipose tissue (WAT) fibrosis - the buildup of extracellular matrix (ECM) proteins, primarily collagen - is now a recognized hallmark of tissue dysfunction and is increased with obesity and lipodystrophy. While growth hormone (GH) is known to increase collagen in several tissues, no previous research has addressed its effect on ECM in WAT. Thus, the purpose of this study is to determine if GH influences WAT fibrosis. DESIGN This study examined WAT from four distinct strains of GH-altered mice (bGH and GHA transgenic mice as well as two tissue specific GH receptor gene disrupted lines, fat growth hormone receptor knockout or FaGHRKO and liver growth hormone receptor knockout or LiGHRKO mice). Collagen content and adipocyte size were studied in all cohorts and compared to littermate controls. In addition, mRNA expression of fibrosis-associated genes was assessed in one cohort (6month old male bovine GH transgenic and WT mice) and cultured 3T3-L1 adipocytes treated with GH. RESULTS Collagen stained area was increased in WAT from bGH mice, was depot-dependent, and increased with age. Furthermore, increased collagen content was associated with decreased adipocyte size in all depots but more dramatic changes in the subcutaneous fat pad. Notably, the increase in collagen was not associated with an increase in collagen gene expression or other genes known to promote fibrosis in WAT, but collagen gene expression was increased with acute GH administration in 3T3-LI cells. In contrast, evaluation of 6month old GH antagonist (GHA) male mice showed significantly decreased collagen in the subcutaneous depot. Lastly, to assess if GH induced collagen deposition directly or indirectly (via IGF-1), fat (Fa) and liver (Li) specific GHRKO mice were evaluated. Decreased fibrosis in FaGHRKO and increased fibrosis in LiGHRKO mice suggest GH is primarily responsible for the alterations in collagen. CONCLUSIONS Our results show that GH action is positively associated with an increase in WAT collagen content as well as a decrease in adipocyte size, particularly in the subcutaneous depot. This effect appears to be due to GH and not IGF-1 and reveals a novel means by which GH regulates WAT accumulation.
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Affiliation(s)
- Lara A Householder
- The Diabetes Institute, Ohio University, Athens, OH, United States; Edison Biotechnology Institute, Ohio University, Athens, OH, United States; School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, United States
| | - Ross Comisford
- The Diabetes Institute, Ohio University, Athens, OH, United States; Edison Biotechnology Institute, Ohio University, Athens, OH, United States
| | - Silvana Duran-Ortiz
- Edison Biotechnology Institute, Ohio University, Athens, OH, United States; School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, United States
| | - Kevin Lee
- The Diabetes Institute, Ohio University, Athens, OH, United States; Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, United States
| | - Katie Troike
- The Diabetes Institute, Ohio University, Athens, OH, United States; Edison Biotechnology Institute, Ohio University, Athens, OH, United States; School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, United States
| | - Cody Wilson
- The Diabetes Institute, Ohio University, Athens, OH, United States; Edison Biotechnology Institute, Ohio University, Athens, OH, United States
| | - Adam Jara
- Edison Biotechnology Institute, Ohio University, Athens, OH, United States
| | - Mitchell Harberson
- The Diabetes Institute, Ohio University, Athens, OH, United States; Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, United States
| | - Edward O List
- Edison Biotechnology Institute, Ohio University, Athens, OH, United States
| | - John J Kopchick
- The Diabetes Institute, Ohio University, Athens, OH, United States; Edison Biotechnology Institute, Ohio University, Athens, OH, United States; Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, United States
| | - Darlene E Berryman
- The Diabetes Institute, Ohio University, Athens, OH, United States; Edison Biotechnology Institute, Ohio University, Athens, OH, United States; Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, United States.
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Kormányos Á, Domsik P, Kalapos A, Valkusz Z, Lengyel C, Forster T, Nemes A. Three-dimensional speckle tracking echocardiography-derived left atrial deformation analysis in acromegaly (Results from the MAGYAR-Path Study). Echocardiography 2018; 35:975-984. [DOI: 10.1111/echo.13860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Árpád Kormányos
- 2nd Department of Medicine and Cardiology Centre; Medical Faculty; Albert Szent-Györgyi Clinical Center; University of Szeged; Szeged Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Centre; Medical Faculty; Albert Szent-Györgyi Clinical Center; University of Szeged; Szeged Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Centre; Medical Faculty; Albert Szent-Györgyi Clinical Center; University of Szeged; Szeged Hungary
| | - Zsuzsanna Valkusz
- 1st Department of Medicine; Medical Faculty; Albert Szent-Györgyi Clinical Center; University of Szeged; Szeged Hungary
| | - Csaba Lengyel
- 1st Department of Medicine; Medical Faculty; Albert Szent-Györgyi Clinical Center; University of Szeged; Szeged Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre; Medical Faculty; Albert Szent-Györgyi Clinical Center; University of Szeged; Szeged Hungary
| | - Attila Nemes
- 2nd Department of Medicine and Cardiology Centre; Medical Faculty; Albert Szent-Györgyi Clinical Center; University of Szeged; Szeged Hungary
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Kormányos Á, Domsik P, Kalapos A, Orosz A, Lengyel C, Valkusz Z, Trencsányi A, Forster T, Nemes A. Left ventricular twist is impaired in acromegaly: Insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:122-128. [PMID: 28990677 DOI: 10.1002/jcu.22529] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/13/2017] [Accepted: 07/20/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Acromegaly is a rare, chronic, disfiguring, and debilitating disease caused, in 90% of cases, by a benign monoclonal growth hormone-secreting pituitary adenoma. The present study aimed to assess left ventricular (LV) rotational and twist mechanics in acromegalic patients and to compare their results to age- and gender-matched healthy controls. METHODS The present study comprised 24 acromegalic patients, from which 4 were excluded due to insufficient image quality (mean age: 57.8 ± 13.7 years, 7 men). The control group consisted of 18 age- and gender-matched healthy individuals (mean age: 54.8 ± 6.9 years, 8 men). RESULTS In 4 out of 20 acromegalic patients, LV showed near absence of twist, as the so-called LV "rigid body rotation" (RBR). Between all acromegalic patients without LV-RBR and controls, both LV basal (-3.76 ± 1.73 vs. -6.17 ± 2.66°, P = .004) and apical rotation (6.12 ± 4.03 vs. 10.81 ± 3.65°, P = .001) and LV twist (9.88 ± 4.74 vs. 16.98 ± 3.88°, P < .001) differed significantly. Between active and nonactive acromegaly subgroups, only the time-to-peak LV twist (377 ± 78 vs. 229 ± 97 ms, P = .005) showed significant difference. CONCLUSIONS Acromegaly is associated with impaired LV rotation and twist as assessed by 3-dimensional speckle tracking echocardiography. LV-RBR is a frequent phenomenon in acromegaly.
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Affiliation(s)
- Árpád Kormányos
- 2nd Department of Medicine and Cardiology Centre, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Centre, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Centre, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- 1st Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Valkusz
- 1st Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Attila Trencsányi
- 1st Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- 2nd Department of Medicine and Cardiology Centre, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Sharma MD, Nguyen AV, Brown S, Robbins RJ. Cardiovascular Disease in Acromegaly. Methodist Debakey Cardiovasc J 2018; 13:64-67. [PMID: 28740584 DOI: 10.14797/mdcj-13-2-64] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In patients with acromegaly, chronic excess of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) leads to the development of acromegalic cardiomyopathy. Its main features are biventricular hypertrophy, diastolic dysfunction, and in later stages, systolic dysfunction and congestive heart failure. Surgical and/or pharmacological treatment of acromegaly and control of cardiovascular risk factors help reverse some of these pathophysiologic changes and decrease the high risk of cardiovascular complications.
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Volschan ICM, Kasuki L, Silva CMS, Alcantara ML, Saraiva RM, Xavier SS, Gadelha MR. Two-dimensional speckle tracking echocardiography demonstrates no effect of active acromegaly on left ventricular strain. Pituitary 2017; 20:349-357. [PMID: 28220351 DOI: 10.1007/s11102-017-0795-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Speckle tracking echocardiography (STE) allows for the study of myocardial strain (ε), a marker of early and subclinical ventricular systolic dysfunction. Cardiac disease may be present in patients with acromegaly; however, STE has never been used to evaluate these patients. OBJECTIVE To evaluate left ventricular (LV) global longitudinal strain in patients with active acromegaly with normal LV systolic function. DESIGN Cross-sectional clinical study. METHODS Patients with active acromegaly with no detectable heart disease and a control group were matched for age, gender, arterial hypertension and diabetes mellitus underwent STE. Global LV longitudinal ε (GLS), left ventricular mass index (LVMi), left ventricular ejection fraction (LVEF) and relative wall thickness (RWT) were obtained via two-dimensional (2D) echocardiography using STE. RESULTS Thirty-seven patients with active acromegaly (mean age 45.6 ± 13.8; 48.6% were males) and 48 controls were included. The mean GLS was not significantly different between the acromegaly group and the control group (in %, -20.1 ± 3.1 vs. -19.4 ± 2.2, p = 0.256). Mean LVMi was increased in the acromegaly group (in g/m2, 101.6 ± 27.1 vs. 73.2 ± 18.6, p < 0.01). There was a negative correlation between LVMi and GLS (r = -0.39, p = 0.01). CONCLUSIONS Acromegaly patients, despite presenting with a higher LVMi when analyzed by 2D echocardiography, did not present with impairment in the strain when compared to a control group; this finding indicates a low chance of evolution to systolic dysfunction and agrees with recent studies that show a lower frequency of cardiac disease in these patients.
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Affiliation(s)
- I C M Volschan
- Cardiology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rodolpho Paulo Rocco, 255, 9th floor, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil.
| | - L Kasuki
- Neuroendocrinology Research Center/ Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
- Endocrine Section, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - C M S Silva
- Neuroendocrinology Research Center/ Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M L Alcantara
- Echocardiographic Section, Hospital Samaritano e Americas Medical City, Rio de Janeiro, Brazil
| | - R M Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - S S Xavier
- Cardiology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rodolpho Paulo Rocco, 255, 9th floor, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil
| | - M R Gadelha
- Neuroendocrinology Research Center/ Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
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Pivonello R, Auriemma RS, Grasso LFS, Pivonello C, Simeoli C, Patalano R, Galdiero M, Colao A. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary 2017; 20:46-62. [PMID: 28224405 DOI: 10.1007/s11102-017-0797-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Acromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemical control of acromegaly significantly improves cardiovascular disease, albeit completely recovering to normal mainly in young patients with short disease duration. Respiratory complications, represented mainly by sleep-breathing disorders, particularly sleep apnea, and respiratory insufficiency, frequently occur at the early stage of the disease and, although their severity decreases with disease control, this improvement does not often change the indication for a specific therapy directed to improve respiratory function. Metabolic complications, including glucose and lipid disorders, are variably reported in acromegaly. Treatments of acromegaly may influence glucose metabolism, and the presence of diabetes mellitus in acromegaly may affect the choice of treatments, so that glucose homeostasis is worth being monitored during the entire course of the disease. Early diagnosis and prompt treatment of acromegaly, aimed at obtaining a strict control of hormone excess, are the best strategy to limit the development or reverse the complications and prevent the premature mortality.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Ludovica F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Chiara Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Mariano Galdiero
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
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Ramos-Leví AM, Marazuela M. Cardiovascular comorbidities in acromegaly: an update on their diagnosis and management. Endocrine 2017; 55:346-359. [PMID: 28042644 DOI: 10.1007/s12020-016-1191-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/25/2016] [Indexed: 01/11/2023]
Abstract
Comorbidities related to the cardiovascular system are one of the most prevalent in patients with acromegaly, and contribute to an increased risk of morbidity and all-cause mortality. Specifically, hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, coronary artery disease, and cardiac dysfunction may be frequent findings. Although the underlying physiopathology for each comorbidity may not be fully elucidated, uncontrolled growth hormone/insulin-like growth factor 1 excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors are significant influencing variables. A simple diagnostic approach to screen for the presence of these comorbidities may allow prompt treatment and arrest the progression of cardiac abnormalities. In this article, we revise the most prevalent cardiovascular comorbidities and their pathophysiology in acromegalic patients, and we address some recommendations for their prompt diagnosis, management and treatment. Strengths and pitfalls of different diagnostic techniques that are currently being used and how different treatments can affect these complications will be further discussed.
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Affiliation(s)
- Ana M Ramos-Leví
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Universidad Autónoma, Madrid, Spain
| | - Mónica Marazuela
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Universidad Autónoma, Madrid, Spain.
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Warszawski L, Kasuki L, Sá R, Dos Santos Silva CM, Volschan I, Gottlieb I, Pedrosa RC, Gadelha MR. Low frequency of cardniac arrhythmias and lack of structural heart disease in medically-naïve acromegaly patients: a prospective study at baseline and after 1 year of somatostatin analogs treatment. Pituitary 2016; 19:582-589. [PMID: 27591859 DOI: 10.1007/s11102-016-0749-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The incidence of arrhythmias may be increased in acromegaly, but the pathophysiologic mechanisms involved are still unclear, and it has never been correlated with structural heart changes analyzed by the gold-standard method cardiac magnetic resonance (CMR). AIM Evaluate the frequency of arrhythmias in drug-naïve acromegaly patients at baseline and after 1 year of somatostatin analogs (SA) treatment and to correlate the occurrence of arrhythmias with the presence of structural heart changes. PATIENTS AND METHODS Consecutive drug-naïve acromegaly patients were recruited. The occurrence of arrhythmias and structural heart changes were studied through 24-h Holter and CMR, respectively, at baseline and after 1-year SA treatment. RESULTS Thirty-six patients were studied at baseline and 28 were re-evaluated after 1 year of SA treatment. There were 13 females and median age was 48 years (20-73 years). Nine patients (32 %) were controlled after treatment. No sustained arrhythmias were reported in the 24-h Holter. No arrhythmia-related symptoms were observed. Only two patients presented left ventricular hypertrophy and three patients presented fibrosis at baseline. There was no correlation of the left ventricular mass with the number of episodes of arrhythmias and they were not more prevalent in the patients presenting cardiac fibrosis. CONCLUSION We found no sustained arrhythmias and a lack of arrhythmia-related symptoms at baseline and after 1 year of SA treatment in a contemporary cohort of acromegaly patients that also present a low frequency of structural heart changes, indicating that these patients may have a lower frequency of heart disease than previously reported.
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Affiliation(s)
- Leila Warszawski
- Neuroendocrinology Research Center - Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, sala 9F, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil
- Endocrine Unit, Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center - Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, sala 9F, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil
- Neuroendocrine Section - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
- Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Rodrigo Sá
- Cardiology Section, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cintia Marques Dos Santos Silva
- Neuroendocrinology Research Center - Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, sala 9F, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil
| | - Isabela Volschan
- Cardiology Section, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ilan Gottlieb
- Clínica de Diagnóstico por Imagem/Multi-Imagem, Rio de Janeiro, Brazil
- Radiology Department, Casa de Saúde São Jose, Rio de Janeiro, Brazil
| | - Roberto Coury Pedrosa
- Cardiology Section, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center - Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, sala 9F, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil.
- Neuroendocrine Section - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.
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dos Santos Silva CM, Gottlieb I, Volschan I, Kasuki L, Warszawski L, Balarini Lima GA, Xavier SS, Pedrosa RC, Neto LV, Gadelha MR. Low Frequency of Cardiomyopathy Using Cardiac Magnetic Resonance Imaging in an Acromegaly Contemporary Cohort. J Clin Endocrinol Metab 2015; 100:4447-55. [PMID: 26431508 DOI: 10.1210/jc.2015-2675] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Left ventricular hypertrophy (LVH) and myocardial fibrosis are considered common findings of the acromegaly cardiomyopathy in echocardiography studies. OBJECTIVE To evaluate the frequency of LVH, systolic dysfunction and myocardial fibrosis was undertaken in patients with acromegaly using cardiac magnetic resonance imaging (CMRi) before and after 12 months of octreotide long-acting repeatable treatment. PATIENTS AND METHODS Consecutive patients with active acromegaly submitted to biochemical analysis and CMRi before and after 12 months of treatment. Additionally, echocardiography was performed before treatment. RESULTS Forty consecutive patients were evaluated using CMRi at baseline and 30 patients were reevaluated after 12 months of treatment. Additionally, 29 of these patients were submitted to echocardiography. Using CMRi, the frequency of LVH was 5%. The mean left ventricular mass index (LVMi) was 61.73 ± 18.8 g/m(2). The mean left ventricular ejection fraction (LVEF) was 61.85 ± 9.2%, and all patients had normal systolic function. Late gadolinium enhancement was present in five patients (13.5%), and one patient (3.5%) had an increased extracellular volume. After treatment, 12 patients (40%) had criteria for disease control. No clinically relevant differences in cardiac variables before and after treatment were observed. Additionally, there was no difference in LVMi and LVEF among patients with and without disease control. Using echocardiography, 31% of the patients had LVH, mean LVMi was 117.8 ± 46.3 g/m(2) and mean LVEF was 67.3 ± 4.4%. All patients had normal systolic function. CONCLUSIONS We demonstrated by CMRi, the gold-standard method, that patients with active acromegaly might have a lower prevalence of cardiac abnormalities than previously reported.
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Affiliation(s)
- Cintia Marques dos Santos Silva
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Ilan Gottlieb
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Isabela Volschan
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Leila Warszawski
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Giovanna Aparecida Balarini Lima
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Sergio Salles Xavier
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Roberto Coury Pedrosa
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Leonardo Vieira Neto
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
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Zelarayán LC, Zafiriou MP, Zimmermann WH. Emerging Concepts in Myocardial Pharmacoregeneration. Regen Med 2013. [DOI: 10.1007/978-94-007-5690-8_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hipertrofia ventricular izquierda como factor de riesgo cardiovascular en el paciente hipertenso. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70372-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Abstract
In acromegaly, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess results in a specific cardiomyopathy characterized by concentric cardiac hypertrophy primarily associated with diastolic dysfunction that can lead to impaired systolic function and eventually heart failure. This review of the literature evaluates the effect of therapeutic intervention on cardiac parameters. Clinical studies investigating the impact of treatments for acromegaly on cardiac function published between January 1980 and January 2009 were identified through electronic searches of Medline. Suppression of GH and IGF-1 following surgery or medical treatment with somatostatin analogue therapy is effective in decreasing left ventricular (LV) hypertrophy, with subsequent improvement in cardiac function. First-line treatment with somatostatin analogues resulted in improved cardiac outcome compared with first-line surgery, possibly due to somatostatin analogues acting directly through somatostatin receptors on cardiac cells. Additional cardiac improvement has been reported when somatostatin analogue treatment was combined with surgery. In patients where complete biochemical control was not achieved, an improved cardiac performance following treatment with somatostatin analogues has been reported. Treatment with pegvisomant has been demonstrated to reduce LV hypertrophy and improve diastolic and systolic performance. In contrast, reports have suggested that treatment with the dopamine agonist cabergoline increased the incidence of valvular heart disease. Although surgery and somatostatin analogues are effective in improving cardiomyopathy, a greater beneficial effect is observed with somatostatin analogue treatment. Selected patients with acromegaly should consider first-line therapy or pre-treatment with somatostatin analogues prior to surgery to achieve biochemical control and improve cardiac dysfunction.
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Affiliation(s)
- Annamaria Colao
- Department of Molecular and Clinical Endocrinology and Oncology, Section of Endocrinology, Federico II University of Naples, Naples, Italy.
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Bencze A, Rácz K. [Acromegalic cardiomyopathy]. Orv Hetil 2011; 152:1875-8. [PMID: 22042313 DOI: 10.1556/oh.2011.29244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acromegaly is an endocrine disease with specific somatic changes due to an excess of growth hormone. The majority of cases are caused by growth hormone producing pituitary tumors. Cardiovascular complications, which can be detected even in the early stages of the disease, are considered as major contributing factors in the increased morbidity and mortality of the patients. In this review authors briefly summarize clinical characteristics of acromegalic cardiomyopathy.
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Affiliation(s)
- Agnes Bencze
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088.
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Deegan RJ, Furman WR. Cardiovascular Manifestations of Endocrine Dysfunction. J Cardiothorac Vasc Anesth 2011; 25:705-20. [DOI: 10.1053/j.jvca.2010.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Indexed: 01/27/2023]
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Myocardial blood flow and fibrosis in hypertrophic cardiomyopathy. J Card Fail 2011; 17:384-91. [PMID: 21549295 DOI: 10.1016/j.cardfail.2011.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/12/2011] [Accepted: 01/19/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND We investigated the relationship between myocardial blood flow (MBF), fibrosis, risk factors for sudden death, and clinical manifestations in hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS Sixty-two patients with HCM (45 men, overall mean age 47 ± 16 years), 15 acromegalic patients with left ventricular hypertrophy (9 man, overall mean age 47 ± 12 years), and 20 healthy subjects underwent cardiac magnetic resonance. Resting MBF was measured as the ratio between coronary sinus flow measured by phase-contrast technique and left ventricular mass. Myocardial fibrosis was evaluated by late gadolinium enhancement (LGE) technique. In HCM patients, MBF was significantly lower than in control subjects and acromegalic patients. Patients with LGE had lower MBF than those without it (0.46 ± 0.2 vs 0.66 ± 0.29 mL·min(-1)·g(-1); P < .005). Patients with ventricular tachycardia at Holter monitoring had lower MBF (0.4 ± 0.14 vs 0.6 ± 0.29 mL·min(-1)·g(-1); P < .04). Among patients with preserved systolic function, those in New York Heart Association (NYHA) functional class ≥II had lower MBF than those in NYHA functional class I (0.46 ± 0.2 vs 0.69 ± 0.3 mL·min(-1)·g(-1); P < .003). MBF was the only independent predictor of worse clinical status (NYHA ≥II; P = .01). CONCLUSIONS In HCM patients low resting MBF is associated with the presence of fibrosis. MBF is a predictor of worse clinical status.
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Bogazzi F, Rossi G, Lombardi M, Raggi F, Urbani C, Sardella C, Cosci C, Martino E. Effect of rosiglitazone on serum IGF-I concentrations in uncontrolled acromegalic patients under conventional medical therapy: results from a pilot phase 2 study. J Endocrinol Invest 2011; 34:e43-51. [PMID: 20671417 DOI: 10.1007/bf03347060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Current therapies for acromegaly are unsatisfactory for some patients. High-dose thiazolidinediones have been reported to reduce serum GH levels in animal models of acromegaly. The objective of the study was to evaluate the effect of increasing doses of rosiglitazone on serum GH and IGF-I concentrations in acromegalic patients. DESIGN Phase 2 clinical trial. PATIENTS AND METHODS Five consecutive patients with active and uncontrolled acromegaly under conventional medical therapies were treated with increasing doses of rosiglitazone [4 mg/day every month, starting from 8 up to 20 mg/day] added to previous medical therapies for acromegaly. RESULTS Mean serum IGF-I concentrations decreased from 547 ± 91 to 265 ± 126 μg/l (p<0,001) during rosiglitazone treatment: 4 patients had normal serum IGF-I concentrations, and a patient had lowered serum IGF-I values, although still abnormal, at the end of the study. On the contrary, serum GH concentrations did not significantly changed during rosiglitazone therapy as well as other pituitary hormones. No relevant side effects of rosiglitazone were observed during the study period. Quantitative real time PCR and Western blotting showed that rosiglitazone lowered GH-dependent hepatic generation of IGF-I in HepG2 cell line. CONCLUSIONS Rosiglitazone reduces serum IGF-I concentrations in patients with uncontrolled acromegaly under conventional medical therapies, likely acting on the GH-dependent hepatic synthesis of IGF-I. Large studies are necessary to confirm the role of rosiglitazone as an adjunctive therapy for uncontrolled acromegalic patients under conventional medical therapies.
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Affiliation(s)
- F Bogazzi
- Department of Endocrinology and Metabolism, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
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Celebi AS, Yalcin H, Yalcin F. Current cardiac imaging techniques for detection of left ventricular mass. Cardiovasc Ultrasound 2010; 8:19. [PMID: 20515461 PMCID: PMC2896933 DOI: 10.1186/1476-7120-8-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 06/01/2010] [Indexed: 12/19/2022] Open
Abstract
Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test.
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Bogazzi F, Lombardi M, Strata E, Aquaro G, Lombardi M, Urbani C, Di Bello V, Cosci C, Sardella C, Talini E, Martino E. Effects of somatostatin analogues on acromegalic cardiomyopathy: results from a prospective study using cardiac magnetic resonance. J Endocrinol Invest 2010; 33:103-8. [PMID: 20348836 DOI: 10.1007/bf03346562] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Left ventricular (LV) hypertrophy is the main finding of patients with active acromegaly at cardiac magnetic resonance (CMR). The aim of the study was to evaluate heart changes in acromegalic patients treated with somatostatin analogues (SMSA) using CMR. DESIGN AND PATIENTS This was a prospective study. Fourteen consecutive patients (8 women, mean age 46+/-10 yr) with untreated active acromegaly were submitted to CMR and 2D-color Doppler echocardiography before and after a 6-month SMSA course. MEASUREMENTS LV volume, mass (LVM) and wall thickness. RESULTS CMR: Mean LVM and LVM index (i) decreased from 151+/-17 g and 77+/-9 g/m2, to 144+/-24 g and 70+/-12 g/m2, respectively (p=0.047 and p<0.0001, respectively); LV hypertrophy reverted in 6 out of 10 patients (p=0.016). Systolic function, evaluated by measuring LV ejection fraction remained normal in all patients (67+/-11%). There was not a correlation between changes in LVMi and changes in serum IGF-I concentrations. However, patients with controlled disease had higher reduction of LVMi than those with uncontrolled acromegaly (DeltaLVMi, -8.2+/-4.2 vs 4.0+/-5.3 p<0.05). 2D-echo cardiography: Mean LVMi decreased from 110+/-24 g/m2 to 100+/-20 g/m2 (p=0.026); hypertrophy, revealed in 5 patients (36%) at baseline, reversed in 2 patients (p=0.500) after SMSA; abnormal diastolic function [evaluated by isovolumic relaxation time or early (E) to late of atrial (A) peak velocities ratio] found in 4 patients (29%) at the study entry, improved in a patient. Systolic function remained within the normal range in all patients during the study period. CONCLUSIONS CMR detects changes in LVMi in most patients with acromegaly treated with SMSA, which are more evident if the disease is controlled.
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Affiliation(s)
- F Bogazzi
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.
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Romanello G, Di Bella G, Minutoli F, Cannavo S. Evaluation of myocardial fibrosis by imaging techniques in acromegaly. Clin Endocrinol (Oxf) 2008; 69:685-6. [PMID: 18394020 DOI: 10.1111/j.1365-2265.2008.03252.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bogazzi F, Lombardi M, Cosci C, Sardella C, Brogioni S, Talini E, Di Bello V, Bartalena L, Martino E. Identification, treatment and management of cardiovascular risks in patients with acromegaly. Expert Rev Endocrinol Metab 2008; 3:603-614. [PMID: 30290414 DOI: 10.1586/17446651.3.5.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acromegaly, a syndrome related to growth hormone/IGF-1 excess, is frequently complicated by cardiovascular abnormalities (acromegalic cardiomyopathy). Extremely frequent are left ventricular hypertrophy and alterations of diastolic filling, which may progress to systolic dysfunction and eventually heart failure. Cardiac abnormalities may normalize after successful medical or surgical treatment of acromegaly, particularly in young patients with short-lasting disease, but this is less likely to occur in elderly patients. Both hypertension and cardiac valve disease are frequently encountered in acromegaly, but neither seems to be favorably influenced by disease control. The prevalence of coronary heart disease (CHD) is controversial but is probably not increased in acromegaly. Arrhythmias are relatively common in untreated acromegalic patients, although their clinical relevance is unknown. A cardiac evaluation of acromegalic patients should include echocardiography, basal electrocardiogram and blood pressure measurement, and evaluation of common risk factors for CHD. Appropriate and prompt treatment allowing a rapid control of growth hormone/IGF-1 hypersecretion is warranted because many features of acromegalic cardiomyopathy may be reverted, particularly in younger patients. In view of the lack of association with acromegaly, common risk factors for CHD, hypertension, arrhythmias or valve disease should be managed independently, irrespective of control of disease activity.
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Affiliation(s)
- Fausto Bogazzi
- a Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy. ;
| | - Martina Lombardi
- b Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy
| | - Chiara Cosci
- b Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy
| | - Chiara Sardella
- b Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy
| | - Sandra Brogioni
- b Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy
| | - Enrica Talini
- c Cardio-Thoracic Department, University of Pisa, 56124 Pisa, Italy
| | | | - Luigi Bartalena
- d Department of Clinical Medicine, University of Insubria, 21100 Varese, Italy
| | - Enio Martino
- b Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy
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