Cardiovascular effects of depot long-acting somatostatin analog sandostatin LAR in acromegaly(428 views) Colao A, Marzullo P, Ferone D, Spinelli L, Cuocolo A, Bonaduce D, Salvatore M, Boerlin V, Lancranjan I, Lombardi G
Affiliations: Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, 80131 Naples, Italy
Department of Internal Medicine I, Federico II University of Naples, 80131 Naples, Italy
Department of Biomorphological and Functional Sciences, National Council for Research, Federico II University of Naples, 80131 Naples, Italy
Scientific Institute for Research and Care Neuromed, Pozzilli, Italy
Novartis Pharma A.G., 4002 Basel, Switzerland
Novartis Pharma A. G., 4002 Basel, Switzerland
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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
Pereira, J. L., Rodriguez-Puras, M. J., Leal-Cerro, A., Acromegalic cardiopathy improves after treatment with increasing doses of octreotide (1991) J Endocrinol Invest, 14, pp. 17-23
Tokgozoglu, S. L., Erbas, T., Aytemir, K., Effects of octreotide on left ventricular mass in acromegaly (1994) Am J Cardiol, 74, pp. 1072-1074
Gillis, J. C., Noble, S., Goa, K. L., Octreotide long-acting release (LAR). A review of its pharmacological properties and therapeutic use in the management of acromegaly (1997) Drugs, 53, pp. 681-699
Stewart, P. M., Kane, K. F., Stewart, S. E., Lancranjan, I., Sheppard, M. C., Depot long-acting somatostatin analog (sandostatin-LAR) is an effective treatment for acromegaly (1995) J Clin Endocrinol Metab, 80, pp. 3267-3272
Sahn, D. J., De Maria, 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 echocardiography measurements (1978) Circulation, 58, pp. 1072-1083
Lim, 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
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
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
Padayatty, S. J., Perrins, E. J., Belchetz, P. E., Octreotide treatment increases exercise capacity in patients with acromegaly (1996) Eur J Endocrinol, 134, pp. 554-559
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
Cardiovascular effects of depot long-acting somatostatin analog sandostatin LAR in acromegaly
Cardiovascular disease is the most severe complication of acromegaly accounting for the increased mortality of these patients. Recently, the slow-release form of octreotide (OCT; Sandostatin LAR, OCT-LAR), for im injection every 28 days, was reported to induce suppression of GH levels below 7.5 mU/L (2.5 μg/L) in 39-75% of patients, and normalization of insulin-like growth factor (IGF)-I levels for age in 64-88% of patients, with an excellent patients' compliance. The aim of the present study was to investigate the early effect of OCT-LAR treatment on the left ventricular (LV) structure and performance in 15 somatostatin analog-naive patients with acromegaly (GH, 94.8 ± 24.9 mU/L; IGF-I, 757.9 ± 66.6 μg/L), focusing on the early effect of GH and IGF-I suppression on the heart. Cardiac structure was investigated by echocardiography, whereas LV performance was investigated by gated-blood-pool scintigraphy, before and after 3 and 6 months of treatment with OCT-LAR. OCT-LAR was initially administered im, at a dose of 20 mg every 28 days, for 3 months. In six patients, the dose was then increased to 30 mg every 28 days to achieve disease control, which was considered when fasting and/or glucose-suppressed GH values were below 7.5 and 3.0 mU/L, respectively, together with IGF-I values within the normal range for age. The treatment with OCT-LAR for 6 months induced a significant decrease of GH (to 12.9 ± 3.0 mU/L) and IGF-I levels (to 340.3 ± 40.2 μg/L) in all 15 patients. After 6 months of treatment, the percent IGF-I suppression was 52.8 ± 4.4%, and serum GH/IGF-I levels were normalized in 9 patients. A significant decrease of LV mass index (LVMi), interventricular septum thickness, and LV posterior wall thickness was observed in all 15 patients after 3 and 6 months of OCT-LAR treatment: LVMi was decreased by 19.1 ± 2.0% without any difference in patients with (19.9 ± 2.7%) or without disease control (17.8 ± 3.3%). Among the 11 patients with LV hypertrophy, 6 normalized their LVMi after treatment. At study entry, an inadequate LV ejection fraction (LVEF) at rest (
Cardiovascular effects of depot long-acting somatostatin analog sandostatin LAR in acromegaly
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