Keywords Parole chiave: Growth Hormone, Somatomedin C, Acromegaly, Adult, Aged, Article, Clinical Article, Controlled Study, Coronary Risk, Exercise, Heart Left Ventricle Ejection Fraction, Heart Left Ventricle Mass, Human, Hyperthyroidism, Priority Journal, Thyrotoxicosis, Antithyroid Agents, Echocardiography, Female, Heart Diseases, Human Growth Hormone, Hypertrophy, Left Ventricular, Insulin-Like Growth Factor I, Iodine Radioisotopes, Longitudinal Studies, Methimazole, Middle Aged, Radionuclide Angiography, Ventricular Function,
Affiliations Affiliazioni: Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, I-80131 Naples, Italy Department of Nuclear Medicine Center, National Council of Research, University Federico II, I-80131 Naples, Italy Department of Biomorphological and Functional Sciences, University Federico II, I-80131 Naples, Italy Scientific Institute for Research and Care Neuromed, Pozzilli 86077, Italy
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Forfar, J.C., Muir, A.I., Sawers, S.A., Toft, A.D., Abnormal left ventricular function in hyperthyroidism: Evidence for a possible reversible cardiomyopathy (1982) N Engl J Med, 307, pp. 1165-1170
Friedman, M.J., Okad, R.D., Ewy, G.A., Hellman, D.J., Left ventricular systolic and diastolic function in hyperthyroidism (1982) Am Heart J, 104, pp. 1303-1308
Chowdhury, D., Parnell, V.A., Ojamaa, K., Boxer, R., Cooper, R., Klein, I., Usefulness of triiodothyronine (T3) treatment after surgery for complex congenital heart disease in infants and children (1999) Am J Cardiol, 84, pp. 1107-1109
Colao, A., Baldelli, R., Marzullo, P., Systemic hypertension and impaired glucose tolerance are independently correlated to the severity of the acromegalic cardiomyopathy (2000) J Clin Endocrinol Metab, 85
Parry, C. H., Collections from the unpublished papers of the late Caleb Hilliel Parry (1825) Dis Heart, 2, pp. 111-125
Sacc, L., Cittadini, A., Fazio, S., Growth hormone and the heart (1994) Endocr Rev, 15, pp. 555-573
Nabarro, J. D. N., Acromegaly (1987) Clin Endocrinol (Oxf), 26, pp. 481-512
Bengtsson, B. -A., Ed n, S., Ernest, I., Oden, A., Sjogren, B., Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984 (1988) Acta Med Scand, 223, pp. 327-335
Bates, A. S., Van't Hoff, W., Jones, J. M., Clayton, R. N., An audit of outcome of treatment in acromegaly (1993) Q J Med, 86, pp. 293-299
Orme, S. M., McNally, R. J., Cartwright, R. A., Belchetz, P. E., Mortality and cancer incidence in acromegaly: A retrospective cohort study (1998) J Clin Endocrinol Metab, 83, pp. 2730-2734. , United Kingdom Acromegaly Study Group
Savage, D. D., Henry, W. L., Eastman, R. C., Rorer, J. S., Gorden, P., Echocardiographic assessment of cardiac anatomy and function in acromegalic patient (1979) Am J Med, 67, pp. 823-828
Rodrigues, E. A., Caruana, M. P., Lahiri, A., Nabarro, J. D. N., Jacobs, H. S., Raftery, E. B., Subclinical cardiac dysfunction in acromegaly: Evidence for a specific disease of heart muscle (1989) Br Heart J, 62, pp. 185-194
L pez-Velasco, R., Escobar-Morreale, H. F., Vega, B., Cardiac involvement in acromegaly: Specific myocardiopathy or consequence of systemic hypertension (1997) J Clin Endocrinol Metab, 82, pp. 1047-1053
Iskandrian, A. S., Rose, L., Hakki, A. H., Segal, B. L., Kane, S. A., Cardiac performance in thyrotoxicosis: Analysis of 10 untreated patients (1983) Am J Cardiol, 51, pp. 349-352
Smallridge, R. C., Goldman, M. H., Raines, K., Rest and exercise left ventricular ejection fraction before and after therapy in young adults with hyperthyroidism and hypothyroidism (1987) Am J Cardiol, 60, pp. 929-931
Woeber, K. A., Thyrotoxicosis and the heart (1992) N Engl J Med, 327, pp. 94-98
Umpierrez, G. E., Chapalli, S., Patterson, C., Congestive heart failure due to reversible cardiomyopathy in patients with hyperthyroidism (1995) Am J Med Sci, 10, pp. 99-102
Seif, F. J., Scherbaum, W. A., Knisel, W., Feine, U., Meinke, J., Struma thyreoidale autonomie und hyperthyreose bei akromegalie (1983), pp. 340-344. , Pickardt C, Schleusener H, Weinheimer B, eds. Schilddruse 1983. Stuttgart, New York: Thieme VerlagMiyakawa, M., Saji, M., Tsushima, T., Wakai, K., Shizume, K., Thyroid volume and serum thyroglobulin levels in patients with acromegaly: Correlation with plasma insulin-like growth factor I levels (1988) J Clin Endocrinol Metab, 67, pp. 973-978
Cheung, N. W., Boyages, S. C., The thyroid gland in acromegaly: An ultrasonographic study (1997) Clin Endocrinol (Oxf), 46, pp. 545-549
Sahn, D. J., De Mafia, A., Kissio, J., Weyman, A., The committee on M-mode standardization of the American Society of Echocardiography. Recommendations regarding quantification in M-mode echocardiography: Results of a survey of echocardiographic measurements (1978) Circulation, 58, pp. 1072-1083
Devereux, R. B., Detection of left ventricular hypertrophy by M-mode echocardiography. Anatomic validation, standardization and comparison to other methods (1987) Hypertension, 9 (SUPPL. 2), pp. II19-II26
Bacharach, S. L., Green, M. V., Borer, J. S., Hyde, J. E., Farkas, S. P., Johnston, G. S., Left ventricular peak ejection rate, filling rate and ejection fraction: Frame requirements at rest and exercise (1979) J Nucl Med, 20, pp. 1889-1893
Carnell, N. E., Valente, W. A., Thyroid nodules in Graves' disease: Classification, characterization, and response to treatment (1998) Thyroid, 8, pp. 571-576
Forfar, J. C., Muir, A. I., Sawers, S. A., Toft, A. D., Abnormal left ventricular function in hyperthyroidism: Evidence for a possible reversible cardiomyopathy (1982) N Engl J Med, 307, pp. 1165-1170
Friedman, M. J., Okad, R. D., Ewy, G. A., Hellman, D. J., Left ventricular systolic and diastolic function in hyperthyroidism (1982) Am Heart J, 104, pp. 1303-1308
Cardiac effect of thyrotoxicosis in acromegaly
Cardiac structure and function are affected both by acromegaly and hyperthyroidism. Whereas the former is mainly characterized by ventricular hypertrophy as well as diastolic and systolic impairment, the latter frequently leads to increased heart rate and enhancement of contractility and cardiac output. To further investigate this issue, we designed this two-arm study. In the first cross-sectional study, we compared echocardiography and radionuclide angiography results obtained in eight hyperthyroid acromegalic patients, eight hyperthyroid nonacromegalic patients, and eight healthy subjects. All acromegalic patients were receiving treatment for acromegaly at the onset of hyperthyroidism. In the second longitudinal study, performed in the group of acromegalic patients, we compared the cardiovascular results obtained during hyperthyroidism with the retrospective data obtained at the initial diagnosis of acromegaly and after 1-yr treatment for this disease and those prospective data obtained during the remission of hyperthyroidism. In the cross-sectional study, hyperthyroid acromegalic patients showed an increase in the left ventricular (LV) mass index (LVMi) compared to healthy and hyperthyroid controls (P < 0.05), with evidence of LVMi hypertrophy in five of them (62.5%). A significant correlation was found between LVMi and GH levels (r = 0.785; P < 0.05). The LV ejection fraction (LVEF) at rest was higher in the control hyperthyroid population than in healthy controls (P < 0.05), whereas the LVEF response to exercise was reduced in acromegalic patients (P < 0.05 vs. healthy controls). In acromegalics, the exercise-induced change in LVEF was significantly reduced compared to that in healthy controls (P < 0.001), but not to that in hyperthyroid controls (P < 0.07), being abnormal (
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