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Impact of Somatostatin Analogs on the Heart in Acromegaly: A Metaanalysis

Service de Pharmacologie Clinique (P.M., A.-I.T., I.M.-M.), Unité de Recherche Clinique (P.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, and University of Paris 12 (P.M.), F-94010 Créteil, France; Institut National de la Santé et de la Recherche Médicale U421 (P.M.), F-94004 Créteil, France; Department of Internal Medicine (A.G.), University of Brescia, 25125 Brescia, Italy; and Service d’Endocrinologie et des Maladies de la Reproduction (P.C.), Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, University of Paris Sud 11 (P.C.), and Institut National de la Santé et de la Recherche Médicale U693 (P.C.), F-94276 Le Kremlin-Bicêtre, France

Address all correspondence and requests for reprints to: Professor P. Chanson, M.D., Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, 78 Rue du Général Leclerc, Le Kremlin-Bicêtre, F-94275, France. E-mail: philippe.chanson{at}bct.ap-hop-paris.fr.

Context: Acromegaly can be complicated by cardiomyopathy. Treatment with somatostatin analogs has been shown to improve some cardiac parameters, but most published clinical trials involved few patients and were not randomized or controlled. In addition, their results are rather variable.

Objective: The objective of the study was to conduct a metaanalysis aimed at obtaining a more accurate picture of the effect of somatostatin analogs on the heart in patients with acromegaly.

Design: We systematically reviewed all studies of somatostatin analogs in acromegaly. Eighteen studies were identified in three databases. We conducted a combined analysis of the effects of somatostatin analogs by using the overall effect size to evaluate significance and by computing the weighted mean differences with and without treatment to assess the effect size.

Results: Somatostatin analog treatment was associated with significant reductions in the heart rate [–5.8 (2.1) beats/min], the left ventricular mass index [–22.3 (6.7) g/m²], interventricular septum thickness [–0.3 (0.2) mm], left ventricular posterior wall thickness [–0.8 (0.4) mm], and the ratio of the E-wave and A-wave peak velocities of the mitral flow profile [0.2 (0.1)]. It was also associated with improved exercise tolerance [1.6 (0.4) min]. Trends toward beneficial effects were noted for the left ventricular end-diastolic dimension [–1.5 (2.2) mm] and the left ventricular ejection fraction [3.3% (1.7%)]. Overall effect sizes were not significant for blood pressure, left ventricular end-systolic dimension, or fractional shortening. Bigger improvements were observed in studies with larger falls in IGF-I and/or GH levels and studies of younger patients.

Conclusion: This metaanalysis confirms that somatostatin analog therapy aimed at achieving stringent control of serum GH/IGF-I concentrations in patients with acromegaly is associated with significant positive effects on morphological and functional hemodynamic parameters.

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