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Left Ventricular Diastolic Function and Cardiac Performance during Exercise in Patients with Acromegaly

Departments of Internal Medicine (L.S., M.P., A.P., D.B.), Biomorphological and Functional Sciences (G.C., A.A.V., A.Cu.), Molecular and Clinical Endocrinology and Oncology (A.Co.), and Institute of Biostructures and Bioimages of the National Council of Research (W.A., A.Cu.), Federico II University, 80131 Naples, Italy; and Scientific Institute for Research and Care Neuromed (G.V., A.Cu.), 86077 Pozzilli, Italy

Address all correspondence and requests for reprints to: Alberto Cuocolo, Department of Biomorphological and Functional Sciences, University Federico II, via Pansini, 5, 80131 Napoli, Italy. E-mail: cuocolo{at}unina.it.

Exercise-induced impairment of left ventricular (LV) ejection fraction is common in patients with acromegaly and normal resting systolic function. This study aimed to clarify whether diastolic dysfunction plays a role in the abnormal adaptation to exercise in these patients. Forty-eight patients with active acromegaly underwent LV radionuclide angiography at rest and during exercise. Doppler echocardiography was also performed to assess LV mass index and diastolic function by combined analysis of mitral and pulmonary flow velocity curves. LV ejection fraction at peak exercise was related to rest ejection fraction (r = 0.78; P < 0.001), peak filling rate (r = 0.55; P < 0.01), LV mass index (r = -0.56; P < 0.001), and the difference between duration of diastolic reverse pulmonary vein flow and mitral flow at atrial contraction ( duration) (r = -0.54; P < 0.01). At stepwise regression analysis, rest ejection fraction and duration were the only variables that independently influenced (P < 0.001) ejection fraction at peak exercise.

Diastolic dysfunction is important in determining cardiac performance during exercise in patients with acromegaly and normal resting systolic function. Combined analysis of pulmonary vein and mitral flow velocity curves allows the identification of impaired LV diastolic function in such patients.

Abbreviations: LV, Left ventricular; PER, peak ejection rate; PFR, peak filling rate.

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