Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance
Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance(314 views) Colao A, Cuocolo A, Marzullo P, Nicolai E, Ferone D, Morte A, Pivonello R, Salvatore M, Lombardi G
Departments of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, 80131 Naples, Italy
Nuclear Medicine Center of the National Council of Research, Department of Biomorphological and Functional Sciences, Federico II University of Naples, 80131 Naples, Italy
Scientific Institute for Research and Care Neuromed, 86077 Pozzilli, Italy
Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, via Sergio Pansini 5, 80131 Naples, Italy
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Bengtsson, B. A., Ed n, S., Ernest, I., Oden, A., Sj gren, B., Epidemiology and long term survival in acromegaly (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
Wright, A. D., Hill, D. M., Lowy, C., Russell Fraser, T., Mortality in acromegaly (1970) Q J Med, 153, pp. 1-16
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Sacc, L., Cittadini, A., Fazio, S., Growth hormone and the heart (1994) Endocr Rev, 15, pp. 555-573
Bertoni, P. D., Morandi, G., Impaired left ventricular diastolic function in acromegaly: An echocardiographic study (1987) Acta Cardiol, 42, pp. 1-10
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
Tokg zoglu, S. L., Erbas, T., Aytemir, K., Effects of octreotide on left ventricular mass in acromegaly (1994) Am J Cardiol, 74, pp. 1072-1074
Lira, M. J., Barkan, A. L., Buda, A. J., Rapid reduction of left ventricular hypertrophy in acromegaly after suppression of growth hormone hypersecretion (1992) Ann Intern Med, 117, pp. 719-726
Bonow, R. O., Bacharach, S. L., Green, M. V., Impaired left ventricular diastolic filling in patients with coronary artery disease: Assessment with radionuclide angiography (1981) Circulation, 64, pp. 315-323
Freda, P. U., Wardlaw, S. L., Post, K. D., Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly (1998) J Neurosurg, 89, pp. 353-358
Lamberts, S. W. J., Van der Lely, A. -J., De Herder, W. W., Hofland, L. J., Octreotide (1996) N Engl J Med, 34, pp. 246-254
B ger, R. H., Skamira, C., Bode-B ger, S. M., Brabant, C., Von Zur Muhlen, A., Frolich, J. C., Nitric oxide mediates the hemodynamic effects of recombinant growth hormone in patients with acquired growth hormone deficiency (1996) J Clin Invest, 98, pp. 2706-2713
Gunal, A. I., Isik, A., Celiker, H., Short term reduction of left ventricular mass in primary hypertrophic cardiomyopathy by octreotide injections (1996) Heart, 76, pp. 418-421
Crick, S. J., Sheppard, M. N., Ho, S. Y., Anderson, R. H., Localisation and quantitation of autonomic innervation in the porcine heart I: Conduction system (1999) J Anat, 195, pp. 341-357
Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance
Acromegalic patients are considered to be exposed to a doubled mortality rate, mostly for cardiovascular diseases. This open prospective study was designed to evaluate whether the impairment of cardiac performance could be reversed by the long-term suppression of GH and insulin-like growth factor I (IGF-I) levels. Eighteen patients with active acromegaly were studied before and 5 yr after surgery, followed by sc octreotide in 11 patients. Disease control (GH levels ≤1 μg/L after glucose load or ≤2.5 μg/L after fasting, respectively, together with normalized IGF-I levels for age) was achieved in seven patients after surgery and in six patients after 0.3-0.6 mg/day sc octreotide. Five patients were not controlled during the 5-yr follow-up. Cardiac performance at rest and at peak exercise was assessed by equilibrium radionuclide angiography at study entry and 5 yr after surgery alone or plus octreotide. Thirty-six sex- and age-matched healthy subjects served as controls. At study entry, patients had a lower left ventricular ejection fraction (LVEF) at peak exercise and LVEF exercise-induced changes, exercise duration, and capacity than controls (P < 0.001). After 5 yr of treatment, a significant decrease of resting heart rate (P = 0.03) and a significant increase of LVEF at peak exercise (P = 0.003) was found in patients achieving disease control. LVEF response at peak exercise worsened in none of the patients with controlled disease and in three patients with uncontrolled disease (60%) (x2 = 5.5; P = 0.02). Diastolic filling, exercise duration, and workload did not significantly change during the 5-yr follow-up. No difference was found between patients controlled by surgery alone or by surgery plus octreotide. This 5-yr prospective study demonstrated that the LVEF response at peak exercise improved in all patients achieving disease control, while it was worsened in 60% of uncontrolled ones. These results strengthen the need of a stable suppression of GH and IGF-I hyper-secretion to restore a normal cardiac performance in acromegaly.
Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance
Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance