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No Greater Incidence or Worsening of Cardiac Valve Regurgitation with Somatostatin Analog Treatment of Acromegaly

Department of Molecular and Clinical Endocrinology and Oncology (A.C.), Federico II University of Naples, 80131 Naples, Italy; 1st School of Medicine (J.M.), Charles University, Prague 12108, Czech Republic; Division of Endocrinology (M.I.G.), Department of Medicine, National Medical Center, Budapest 1135, Hungary; Department of Endocrinology and Metabolic Diseases (P.C.), Centre Hospitalier Universitaire Larrey, Toulouse 31059, France; Institut National de la Santé et de la Recherche Médicale 0204 (J.M.K.), Hôpital Centre d’Investigation Clinique, Charles Nicolle, Rouen 76031, France; Department of Endocrinology and Metabolism (F.M.M.), University of Genova, 16132 Genova, Italy; and Cardiovascular Research Institute/Washington Hospital Center (N.J.W.), Washington, DC 20010

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 Napoli, Italy. E-mail: colao{at}unina.it.

Context: Excess GH and IGF-I in acromegaly are associated with reduced life expectancy due to cardiovascular complications.

Objective: The objective of the study was to investigate the prevalence, incidence, and severity of cardiac valve regurgitation before and after somatostatin-analog treatment in acromegaly.

Design: This was a prospective, observer-blinded, multicenter, 12-month study.

Setting: The study was conducted at 33 specialist centers.

Patients: The study population consisted of 225 adult patients with acromegaly without significant cardiac valve abnormalities or prior valve-replacement surgery, matched for age, sex, and center/country/study.

Interventions: Interventions included initiation/continuation of lanreotide (n = 107) or octreotide treatment (n = 118), tailored for optimal disease control.

Main Outcome Measures: Relative risk of new/worsening regurgitation in any valve at 12 months compared with baseline, was measured.

Results: At baseline, almost 80% of patients had some degree of cardiac valve regurgitation, although none was severe. The risk of developing new/worsening regurgitation in any valve at 12 months was nonsignificant and similar for the cohorts [adjusted odds ratio 0.86; 95% confidence interval (CI) 0.41–1.82; P = 0.694; relative risk 1.04; 95% CI 0.67–1.60; risk difference 0.01; 95% CI –0.13 to 0.16]. For 54% of patients, the severity of regurgitation stayed the same during the study. At baseline, significant valve regurgitation occurred in 18% of patients (lanreotide cohort) and 13% (octreotide cohort) and at 12 months in 18% of each cohort.

Conclusions: The incidence of valve regurgitation did not change over 12 months of treatment with somatostatin analogs, and most cases were physiologic or mild in severity. There was no significant difference between somatostatin analogs in the risk of developing new/worsening valve regurgitation or significant regurgitation after 1 yr.