This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by López-Velasco, R. Articles by García-Robles, R. Search for Related Content PubMed PubMed Citation Articles by López-Velasco, R. Articles by García-Robles, R.

Cardiac Involvement in Acromegaly: Specific Myocardiopathy or Consequence of Systemic Hypertension?¹

Departments of Endocrinology and Cardiology (J.L.M.-M.), Hospital Ramón y Cajal, Madrid, Spain

Address all correspondence and requests for reprints to: Dr. Rafael García-Robles, Servicio de Endocrinología, Hospital Ramón y Cajal, Crta. de Colmenar, Km 9.100, 28034 Madrid, Spain.

To evaluate the relative contributions of past or present GH hypersecretion and of hypertension to the cardiac abnormalities present in acromegaly, we have studied the serum GH and insulin-like growth factor I concentrations, systolic and diastolic blood pressures, and morphological and functional cardiac indexes as measured by echocardiography-Doppler, in 39 patients with active or cured acromegaly, 16 hypertensive controls, and 17 normotensive controls.

Hypertension was present in 42.8% of patients with active acromegaly and in 28.0% of patients in which acromegaly was cured. Hypertension was independently related to an increase in indexes of cardiac morphology (left ventricular mass, left ventricular posterior wall thickness, interventricular septum thickness, relative wall thickness with respect to the diastolic diameter of the left ventricle, and left atrial end-systolic diameter), systolic function (stroke volume, fractional shortening, and end-systolic stress), and diastolic function (isovolumic relaxation time and maximal late diastolic flow velocity) and to a reduction in the early to late maximal diastolic flow velocity ratio. Acromegaly was related to an increase in left ventricular mass, stroke volume, cardiac output, and isovolumic relaxation time, which were independent from the presence of hypertension. End-systolic stress was reduced by acromegaly. In the five patients in which active acromegaly was successfully treated, left ventricular mass and left ventricular posterior wall thickness were reduced 1 yr later.

In conclusion, the asymptomatic morphological and functional cardiac abnormalities present in acromegalic patients are independently related to acromegaly and hypertension, pointing to the existence to a specific acromegalic myocardiopathy that might be aggravated by the coexistence of hypertension.

This article has been cited by other articles:

				H. Gouya, O. Vignaux, P. Le Roux, P. Chanson, J. Bertherat, X. Bertagna, and P. Legmann Rapidly Reversible Myocardial Edema in Patients with Acromegaly: Assessment with Ultrafast T2 Mapping in a Single-Breath-Hold MRI Sequence Am. J. Roentgenol., June 1, 2008; 190(6): 1576 - 1582. [Abstract] [Full Text] [PDF]

				E. R. Schwarz, P. Jammula, R. Gupta, and S. Rosanio A Case and Review of Acromegaly-Induced Cardiomyopathy and the Relationship Between Growth Hormone and Heart Failure: Cause or Cure or Neither or Both? Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2006; 11(4): 232 - 244. [Abstract] [PDF]

				E. C. Nemergut, A. S. Dumont, U. T. Barry, and E. R. Laws Perioperative Management of Patients Undergoing Transsphenoidal Pituitary Surgery Anesth. Analg., October 1, 2005; 101(4): 1170 - 1181. [Abstract] [Full Text] [PDF]

				H. Bihan, C. Espinosa, H. Valdes-Socin, S. Salenave, J. Young, S. Levasseur, P. Assayag, A. Beckers, and P. Chanson Long-Term Outcome of Patients with Acromegaly and Congestive Heart Failure J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5308 - 5313. [Abstract] [Full Text] [PDF]

				A. Colao, D. Ferone, P. Marzullo, and G. Lombardi Systemic Complications of Acromegaly: Epidemiology, Pathogenesis, and Management Endocr. Rev., February 1, 2004; 25(1): 102 - 152. [Abstract] [Full Text] [PDF]

				A. Colao, L. Spinelli, A. Cuocolo, S. Spiezia, R. Pivonello, C. di Somma, D. Bonaduce, M. Salvatore, and G. Lombardi Cardiovascular Consequences of Early-Onset Growth Hormone Excess J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3097 - 3104. [Abstract] [Full Text] [PDF]

				M. Galderisi, G. Vitale, G. Lupoli, M. Barbieri, G. Varricchio, C. Carella, O. de Divitiis, and G. Paolisso Inverse Association Between Free Insulin-Like Growth Factor-1 and Isovolumic Relaxation in Arterial Systemic Hypertension Hypertension, October 1, 2001; 38(4): 840 - 845. [Abstract] [Full Text] [PDF]

				A. Colao, C. di Somma, A. Cuocolo, L. Spinelli, N. Tedesco, R. Pivonello, D. Bonaduce, M. Salvatore, and G. Lombardi Improved Cardiovascular Risk Factors and Cardiac Performance after 12 Months of Growth Hormone (GH) Replacement in Young Adult Patients with GH Deficiency J. Clin. Endocrinol. Metab., May 1, 2001; 86(5): 1874 - 1881. [Abstract] [Full Text]

				A. Colao, A. Cuocolo, P. Marzullo, E. Nicolai, D. Ferone, A. M. Della Morte, R. Pivonello, M. Salvatore, and G. Lombardi Is the Acromegalic Cardiomyopathy Reversible? Effect of 5-Year Normalization of Growth Hormone and Insulin-Like Growth Factor I Levels on Cardiac Performance J. Clin. Endocrinol. Metab., April 1, 2001; 86(4): 1551 - 1557. [Abstract] [Full Text]

				T. Sas, P. Mulder, and A. Hokken-Koelega Body Composition, Blood Pressure, and Lipid Metabolism before and during Long-Term Growth Hormone (GH) Treatment in Children with Short Stature Born Small for Gestational Age Either with or without GH Deficiency J. Clin. Endocrinol. Metab., October 1, 2000; 85(10): 3786 - 3792. [Abstract] [Full Text]

				A. Colao, P. Marzullo, D. Ferone, L. Spinelli, A. Cuocolo, D. Bonaduce, M. Salvatore, V. Boerlin, I. Lancranjan, and G. Lombardi Cardiovascular Effects of Depot Long-Acting Somatostatin Analog Sandostatin LAR in Acromegaly J. Clin. Endocrinol. Metab., September 1, 2000; 85(9): 3132 - 3140. [Abstract] [Full Text]

				E. Bollano, E. Omerovic, M. Bohlooly-Y, V. Kujacic, B. Madhu, J. Tornell, O. Isaksson, B. Soussi, W. Schulze, M. L. X. Fu, et al. Impairment of Cardiac Function and Bioenergetics in Adult Transgenic Mice Overexpressing the Bovine Growth Hormone Gene Endocrinology, June 1, 2000; 141(6): 2229 - 2235. [Abstract] [Full Text] [PDF]

				P. Marzullo, A. Cuocolo, D. Ferone, R. Pivonello, M. Salvatore, G. Lombardi, and A. Colao Cardiac Effect of Thyrotoxicosis in Acromegaly J. Clin. Endocrinol. Metab., April 1, 2000; 85(4): 1426 - 1432. [Abstract] [Full Text]

				A. Colao, R. Baldelli, P. Marzullo, E. Ferretti, D. Ferone, P. Gargiulo, M. Petretta, G. Tamburrano, G. Lombardi, and A. Liuzzi Systemic Hypertension and Impaired Glucose Tolerance Are Independently Correlated to the Severity of the Acromegalic Cardiomyopathy J. Clin. Endocrinol. Metab., January 1, 2000; 85(1): 193 - 199. [Abstract] [Full Text]

				A. Colao, A. Cuocolo, P. Marzullo, E. Nicolai, D. Ferone, A. M. D. Morte, M. Petretta, M. Salvatore, and G. Lombardi Impact of Patient's Age and Disease Duration on Cardiac Performance in Acromegaly: A Radionuclide Angiography Study J. Clin. Endocrinol. Metab., May 1, 1999; 84(5): 1518 - 1523. [Abstract] [Full Text]

				R. Baldelli, E. Ferretti, M.-L. Jaffrain-Rea, G. Iacobellis, G. Minniti, B. Caracciolo, C. Moroni, R. Cassone, A. Gulino, and G. Tamburrano Cardiac Effects of Slow-Release Lanreotide, a Slow-Release Somatostatin Analog, in Acromegalic Patients J. Clin. Endocrinol. Metab., February 1, 1999; 84(2): 527 - 532. [Abstract] [Full Text]

				A. Colao, A. Cuocolo, P. Marzullo, E. Nicolai, D. Ferone, L. Florimonte, M. Salvatore, and G. Lombardi Effects of 1-Year Treatment with Octreotide on Cardiac Performance in Patients with Acromegaly J. Clin. Endocrinol. Metab., January 1, 1999; 84(1): 17 - 23. [Abstract] [Full Text]