Objective: To investigate whether first-line surgery or SSA have a different outcome on cardiomyopathy after 12 months.

Design: Retrospective, comparative, non randomized.

Patients: 56 patients treated with SSA and 33 operated on by transsphenoidal approach. For the purposes of this study only controlled patients were included.

Measurements: Primary outcome measures were changes in left ventricular mass index (LVMi), diastolic [early to atrial mitral flow velocity (E/A)] and systolic performance [LV ejection fraction (LVEF)]. Secondary outcome measures were reduction of total/HDL-cholesterol ratio, as a cardiovascular (CV) risk parameter, improvement of glucose profile and pituitary function, as indirect causes of CV improvement.

Results: SSA and surgery groups were similar for gender, age, estimated disease duration, GH, and IGF-I levels, severity of cardiomyopathy lipid and glucose profile. 12 months after treatment in both groups, LVMi, E/A, diastolic blood pressure and heart rate decreased significantly while only in SSA-treated patients LVEF increased significantly. The total/HDL-cholesterol ratio significantly reduced only in SSA-treated patients while fasting glucose levels significantly reduced only in surgery-treated patients. A normal pituitary function was found in 46.4% of SSA- and in 36.4% of surgery-treated patients resulting unchanged in the former and slightly reduced in the latter.

Conclusions: 12 months after first-line treatment with SSA or surgery we found a similar improvement in LV hypertrophy and diastolic filling. In contrast, systolic function improved more evidently in SSA-treated patients. Both a direct effect of SSA and a more preserved pituitary function might explain these results.