This Article Full Text Full Text (PDF) Submit a related Letter to the Editor 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 Colao, A. Articles by Liuzzi, A. Search for Related Content PubMed PubMed Citation Articles by Colao, A. Articles by Liuzzi, A.

Systemic Hypertension and Impaired Glucose Tolerance Are Independently Correlated to the Severity of the Acromegalic Cardiomyopathy¹

Departments of Molecular and Clinical Endocrinology and Oncology (A.C., P.M., D.F., G.L.) and Internal Medicine I (M.P.), Federico II University of Naples; Department of Clinical Science, Section of Endocrinology, University La Sapienza (R.B., E.F., P.G., G.T.), Rome; and Division of Endocrinology, S. Giuseppe Hospital, IRCCS, Istituto Auxologico Italiano (A.L.), Verbania, Italy

Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, via S. Pansini 5, 80131 Naples, Italy. E-mail: colao{at}unina.it

Increased mortality from cardiovascular diseases has been reported in acromegaly. Our objective was to evaluate the impact of glucose tolerance abnormalities and/or systemic hypertension in further worsening the acromegalic cardiomyopathy. The study design was open transversal. The subjects studied were 130 consecutive naive acromegalic patients (74 women and 56 men; age, 17–80 yr). Interventricular septum (IST) and left ventricular (LV) posterior wall thickness (PWT), LV mass index (LVMi), maximal early to late diastolic flow velocity ratio (E/A), isovolumic relaxation time (IRT), and LV ejection fraction (EF) were measured by echocardiography. The results were analyzed in line with the presence of glucose tolerance abnormalities (normal in 60, impaired in 38, diabetes mellitus in 32) and the presence (in 46) or absence (in 84) of hypertension. Patients with impaired glucose tolerance and diabetes mellitus had significantly higher age (P = 0.01), and systolic (P = 0.01) and diastolic (P = 0.01) blood pressures and lower E/A (P = 0.01) and EF (P = 0.01) than those with normal glucose tolerance. Disease duration, circulating GH and insulin-like growth factor I (IGF-I) levels, IST, LVPWT, LVMi, and IRT were similar in the 3 groups. Normotensive patients had significantly lower age (P < 0.001), LVPWT (P < 0.001), IST (P = 0.003), LVMi (P < 0.001), and IRT (P = 0.02) and significantly higher E/A (P < 0.001) and EF (P < 0.001) than hypertensive subjects. Disease duration, circulating GH, and IGF-I levels were similar in the 2 groups.

Multiple regression analysis showed that systolic blood pressure was the strongest predictor of LVMi (P = 0.0004), followed by GH levels (P = 0.02), whereas diastolic blood pressure was the strongest predictor of LVEF reduction (P < 0.0001), followed by glucose tolerance status (P = 0.02). Age was the strongest predictor of both E/A impairment (P < 0.0001) and IRT (P = 0.01), followed by IGF-I levels (P = 0.02).

Compared to patients with uncomplicated acromegaly, those with hypertension but without abnormalities of glucose tolerance had an increased prevalence of LV hypertrophy (75% vs. 37.2%) as well as of impaired diastolic (50% vs. 7.8%) and systolic function (18.7% vs. 3.9%), whereas patients with glucose tolerance abnormalities but without hypertension had only an increased prevalence of impaired diastolic (39.7%) and systolic function (31.7%). The subgroup of acromegalic patients suffering from hypertension and diabetes mellitus had the highest prevalence of LV hypertrophy (84.6%), diastolic filling abnormalities (69.2%), and impaired systolic function at rest (53.9%). A careful cardiac investigation should thus be performed in all acromegalic patients showing these complications.

This article has been cited by other articles:

				A. Colao, R. S. Auriemma, S. Savastano, M. Galdiero, L. F. S. Grasso, G. Lombardi, and R. Pivonello Glucose Tolerance and Somatostatin Analog Treatment in Acromegaly: A 12-Month Study J. Clin. Endocrinol. Metab., August 1, 2009; 94(8): 2907 - 2914. [Abstract] [Full Text] [PDF]

				R. Pivonello, M. Galderisi, R. S. Auriemma, M. C. De Martino, M. Galdiero, A. Ciccarelli, A. D'Errico, I. Kourides, P. Burman, G. Lombardi, et al. Treatment with Growth Hormone Receptor Antagonist in Acromegaly: Effect on Cardiac Structure and Performance J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 476 - 482. [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]

				C. L. Ronchi, V. Varca, P. Beck-Peccoz, E. Orsi, F. Donadio, A. Baccarelli, C. Giavoli, E. Ferrante, A. Lania, A. Spada, et al. Comparison between Six-Year Therapy with Long-Acting Somatostatin Analogs and Successful Surgery in Acromegaly: Effects on Cardiovascular Risk Factors J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 121 - 128. [Abstract] [Full Text] [PDF]

				W. H T Smith, R U. Nair, D. Adamson, M. T Kearney, S. G Ball, and A. J Balmforth Somatostatin receptor subtype expression in the human heart: differential expression by myocytes and fibroblasts J. Endocrinol., December 1, 2005; 187(3): 379 - 386. [Abstract] [Full Text] [PDF]

				A. L. Barkan, P. Burman, D. R. Clemmons, W. M. Drake, R. F. Gagel, P. E. Harris, P. J. Trainer, A. J. van der Lely, and M. L. Vance Glucose Homeostasis and Safety in Patients with Acromegaly Converted from Long-Acting Octreotide to Pegvisomant J. Clin. Endocrinol. Metab., October 1, 2005; 90(10): 5684 - 5691. [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]

				D. Rizzoni, E. Porteri, A. Giustina, C. De Ciuceis, I. Sleiman, G. E. M. Boari, M. Castellano, M. L. Muiesan, S. Bonadonna, A. Burattin, et al. Acromegalic Patients Show the Presence of Hypertrophic Remodeling of Subcutaneous Small Resistance Arteries Hypertension, March 1, 2004; 43(3): 561 - 565. [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]

				R. Scarpa, D. De Brasi, R. Pivonello, P. Marzullo, F. Manguso, A. Sodano, P. Oriente, G. Lombardi, and A. Colao Acromegalic Axial Arthropathy: A Clinical Case-Control Study J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 598 - 603. [Abstract] [Full Text] [PDF]

				O. Serri, C. Beauregard, and J. Hardy Long-Term Biochemical Status and Disease-Related Morbidity in 53 Postoperative Patients with Acromegaly J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 658 - 661. [Abstract] [Full Text] [PDF]

				A. Colao, L. Spinelli, P. Marzullo, R. Pivonello, M. Petretta, C. Di Somma, G. Vitale, D. Bonaduce, and G. Lombardi High Prevalence of Cardiac Valve Disease in Acromegaly: An Observational, Analytical, Case-Control Study J. Clin. Endocrinol. Metab., July 1, 2003; 88(7): 3196 - 3201. [Abstract] [Full Text] [PDF]

				R. N. Clayton Cardiovascular Function in Acromegaly Endocr. Rev., June 1, 2003; 24(3): 272 - 277. [Abstract] [Full Text] [PDF]

				M. K. Rutter, H. Parise, E. J. Benjamin, D. Levy, M. G. Larson, J. B. Meigs, R. W. Nesto, P. W.F. Wilson, and R. S. Vasan Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function: Sex-Related Differences in the Framingham Heart Study Circulation, January 28, 2003; 107(3): 448 - 454. [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]

				C. Parkinson, W. M. Drake, M. E. Roberts, K. Meeran, G. M. Besser, and P. J. Trainer A Comparison of the Effects of Pegvisomant and Octreotide on Glucose, Insulin, Gastrin, Cholecystokinin, and Pancreatic Polypeptide Responses to Oral Glucose and a Standard Mixed Meal J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1797 - 1804. [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]

				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]