Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide
Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide(369 views visite) Colao A, Marzullo P, Cuocolo A, Spinelli L, Pivonello R, Bonaduce D, Salvatore M, Lombardi G
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L pez-Velasco, R., Escobar-Morreale, H. F., Vega, B., Villa, E., Sancho, J. M., Moya-Mur, J. L., Garcia-Robles, R., Cardiac involvement in acromegaly: Specific myocardiopathy or consequence of systemic hypertension (1997) Journal of Clinical Endocrinology Metabolism, 82, pp. 1047-1053
McGuffin W. L., Jr., Sherman, B. M., Roth, J., Gorden, P., Kahn, C. R., Roberts, W. C., Frommer, P. L., Acromegaly and cardiovascular disorders: A prospective study (1974) Annals of Internal Medicine, 81, pp. 11-18
Orme, S. M., McNally, R. J., Cartwright, R. A., Belchetz, P. E., Mortality and cancer incidence in acromegaly: A retrospective cohort study (1998) Journal of Clinical Endocrinology and Metabolism, 83, pp. 2730-2734. , United Kingdom Acromegaly Study Group
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Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide
BACKGROUND: Cardiovascular disease is the most frequent cause of death of patients with acromegaly. AIM To investigate whether young patients with a presumed short disease duration are more likely to reverse the acromegalic cardiomyopathy than older patients with longer disease duration. DESIGN: An open prospective design. PATIENTS: Ten young (aged < 40 years), and 12 middle-aged (41-59 years) patients with active acromegaly well controlled after 12 months of treatment with the depot formulation of octreotide (OCT-LAR); 22 sex- and age-matched healthy subjects as controls. METHODS: Left ventricular (LV) mass (LVM) by echocardiography and performance by equilibrium radionuclide angiography were measured before and after 12 months of OCT-LAR treatment. RESULTS: At study entry, none of the controls and 14 patients (63.4%) of whom six were young (χ2 = 17.7; P < 0.0001) had LV hypertrophy (LVH); none of the controls and four patients of whom one was young had insufficient LV ejection fraction (LVEF) at rest (< 50%); one control and 13 patients (59.1%) of whom five were young (χ2= 12.7; P < 0.0001) had inadequate LVEF at peak exercise (ΔLVEF; < 5% increase of baseline). After 12 months, no change in haemodynamic and diastolic parameters was observed in both groups, except for a significant decrease in heart rate at peak exercise in young patients (P < 0.0001). The LVM index decreased significantly in both young (124.4 ± 5.8 vs. 103.4 ± 3.9 g/m2; P = 0.01) and middle-aged patients (140.9 ± 7.9 vs. 117.8 ± 6.6 g/m2; P= 0.03). LVH disappeared in 10 of 14 patients (71.4%): all six young and four of eight middle-aged patients (50%). LVEF at rest and at peak exercise increased significantly in both groups but ΔLVEF increased significantly only in young patients (1.5 ± 2.9 vs. 13.7 ± 5.2%, P= 0.04); it normalized in nine of 13 patients (69.2%), four of five young (80%) and four of eight middle-aged patients (50%). Exercise capacity (82.5 ± 5.3 vs. 110.0 ± 5.5 W, P= 0.005) and duration (7.3 ± 0.3 vs. 9.9 ± 0.4 min, P = 0.0003) also increased only in young patients. CONCLUSIONS: The acromegalic cardiomyopathy is reversed in most young patients with short disease duration and achieving disease control after OCT-LAR treatment for 12 months, indicating that early diagnosis and effective treatment are essential.
Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide
Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide
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