Journal of Endocrinological Investigation

, Volume 33, Issue 2, pp 103–108 | Cite as

Effects of somatostatin analogues on acromegalic cardiomyopathy: Results from a prospective study using cardiac magnetic resonance

  • F. Bogazzi
  • M. Lombardi
  • E. Strata
  • G. Aquaro
  • M. Lombardi
  • C. Urbani
  • V. Di Bello
  • C. Cosci
  • C. Sardella
  • E. Talini
  • E. Martino
Original Articles
First Online:
Accepted:

Abstract

Objective: Left ventricular (LV) hypertrophy is the main finding of patients with active acromegaly at cardiac magnetic resonance (CMR). The aim of the study was to evaluate heart changes in acromegalic patients treated with somatostatin analogues (SMSA) using CMR. Design and patients: This was a prospective study. Fourteen consecutive patients (8 women, mean age 46±10 yr) with untreated active acromegaly were submitted to CMR and 2D-color Doppler echocardiography before and after a 6-month SMSA course. Measurements: LV volume, mass (LVM) and wall thickness. Results: CMR: Mean LVM and LVM index (i) decreased from 151±17 g and 77±9 g/m2, to 144±24 g and 70±12 g/m2, respectively (p=0.047 and p<0.0001, respectively); LV hypertrophy reverted in 6 out of 10 patients (p=0.016). Systolic function, evaluated by measuring LV ejection fraction remained normal in all patients (67±11%). There was not a correlation between changes in LVMi and changes in serum IGF-I concentrations. However, patients with controlled disease had higher reduction of LVMi than those with uncontrolled acromegaly (ΔLV-Mi, −8.2±4.2 vs 4.0±5.3 p<0.05). 2D-echocardiography: Mean LVMi decreased from 110±24 g/m2 to 100±20 g/m2 (p=0.026); hypertrophy, revealed in 5 patients (36%) at baseline, reversed in 2 patients (p=0.500) after SMSA; abnormal diastolic function [evaluated by isovolumic relaxation time or early (E) to late of atrial (A) peak velocities ratio] found in 4 patients (29%) at the study entry, improved in a patient. Systolic function remained within the normal range in all patients during the study period. Conclusions: CMR detects changes in LVMi in most patients with acromegaly treated with SMSA, which are more evident if the disease is controlled.

Keywords

Acromegaly CMR GH heart IGF-I somatostatin analogues 
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References

  1. 1.
    Bogazzi F, Lombardi M, Strata E, et al. High prevalence of cardiac hypertrophy without detectable signs of fibrosis in patients with untreated active acromegaly: an in vivo study using magnetic resonance imaging. Clin Endocrinol 2008, 68: 361–8.Google Scholar
  2. 2.
    Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004, 25: 102–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Saccà L, Cittadini A, Fazio S. Growth hormone and the heart. Endocr Rev 1994, 15: 555–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Ciulla M, Arosio M, Barelli MV, et al. Blood-pressure independent cardiac hypertrophy in acromegalic patients. J Hypertens 1999, 17: 1965–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Clayton RN. Cardiovascular function in acromegaly. Endocr Rev 2003, 24: 272–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Colao AM, Marzullo P, Di Somma C, Lombardi G. Growth hormone and the heart. Clin Endocrinol (Oxf) 2001, 54: 137–54.CrossRefGoogle Scholar
  7. 7.
    Fazio S, Cittadini A, Cuocolo A, et al. Impaired cardiac performance is a distinct feature of uncomplicated acromegaly. J Clin Endocrinol Metab 1994, 79: 441–6.PubMedGoogle Scholar
  8. 8.
    Colao A, Marzullo P, Cuocolo A, al. 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. Clin Endocrinol (Oxf) 2003, 58: 176–96.CrossRefGoogle Scholar
  9. 9.
    Merola B, Cittadini A, Colao A, et al. Chronic treatment with the somatostatin analog octreotide improves cardiac abnormalities in acromegaly. J Clin Endocrinol Metab 1993, 77: 790–3.PubMedGoogle Scholar
  10. 10.
    Lombardi G, Colao A, Ferone D, et al. Cardiovascular aspects in acromegaly: effect of treatment. Metabolism 1996, 45 (Suppl 1): 57–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Colao A, Marzullo P, Lombardi G. Effect of six-month treatment with lanreotide on cardiovascular risk factors and arterial intima-media thickness in patients with acromegaly. Eur J Endocrinol 2002, 146: 303–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Vianna CB, Vieira MLC, Mady C, et al. Treatment of acromegaly improves myocardial abnormalities. Am Heart J 2002, 143: 873–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Bogazzi F, Di Bello V, Palagi C, et al. Improvement of intrinsic myocardial contractility and cardiac fibrosis degree in acromegalic patients treated with somatostatin analogues: a prospective study. Clin Endocrinol (Oxf) 2005, 62: 590–6.CrossRefGoogle Scholar
  14. 14.
    Morvan D, Komajda M, Grimaldi A, Turpin G, Grosgogeat Y. Cardiac hypertrophy and function in asympotamatic acromegaly. Eur Heart J 1991, 12: 666–72.PubMedGoogle Scholar
  15. 15.
    Pivonello R, Galderisi M, Auriemma RS, et al. Treatment with GH receptor antagonist in acromegaly: effect on cardiac structure and performance. J Clin Endocrinol Metab 2007, 92: 476–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Di Bello V, Bogazzi F, Di Cori A, et al. Myocardial systolic strain abnormalities in patients with acromegaly: a prospective color Doppler imaging study. J Endocrinol Invest 2006, 29: 544–50.PubMedCrossRefGoogle Scholar
  17. 17.
    Marcu CB, Nijveldt R, Beek AM, Van Rossum AC. Delayed contrast enhancement magnetic resonance imaging for the assessment of cardiac disease. Heart Lung Circ 2007, 16: 70–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Pennell DJ, Sechtem UP, Higgins CB, et al; Society for Cardiovascular Magnetic Resonance; Working Group on Cardiovascular Magnetic Resonance of the European Society of Cardiology. Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report. Eur Heart J 2004, 25: 1940–65.PubMedCrossRefGoogle Scholar
  19. 19.
    Colao A, Martino E, Cappabianca P, Cozzi R, Scanarini M, Ghigo E; A.L.I.C.E. Study Group. First-line therapy of acromegaly: a statement of the A.L.I.C.E. (Acromegaly primary medical treatment Learning and Improvement with Continuous Medical Education) Study Group. J Endocrinol Invest 2006, 29: 1017–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU. Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging 2003, 17: 323–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Maceira AM, Prasad SK, Khan M, Pennell DJ. Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance. Eur Heart J 2006, 27: 2879–88.PubMedCrossRefGoogle Scholar
  22. 22.
    Manetti L, Lupi I, Morselli LL, et al. Prevalence and functional significance of antipituitary antibodies in patients with autoimmune and non-autoimmune thyroid diseases. J Clin Endocrinol Metab 2007, 92: 2176–81.PubMedCrossRefGoogle Scholar
  23. 23.
    Lombardi M, Bartolozzi C eds. MRI of the heart and vessels. Milan-Berlin-Heidelberg-New York: Springer-Verlag 2005.Google Scholar
  24. 24.
    Vitale G, Pivonello R, Galderisi M, et al. Cardiovascular complications in acromegaly: methods of assessment. Pituitary 2001, 4: 251–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Colao A, Marzullo P, Ferone D, et al. Cardiovascular effects of depot long-acting somatostatin analog Sandostatin LAR in acromegaly. J Clin Endocrinol Metab 2000, 85: 3132–40.PubMedGoogle Scholar
  26. 26.
    Baldelli R, Ferretti E, Jaffrain-Rea ML, et al. Cardiac effects of lanreotide, a slow-release somatostatin analog in acromegalic patients. J Clin Endocrinol Metab 1999, 84: 527–32.PubMedGoogle Scholar
  27. 27.
    Colao A, Cuocolo A, Marzullo P, et al. Effects of 1-year treatment with octreotide on cardiac performance in patients with acromegaly. J Clin Endocrinol Metab 1999, 84: 17–23.PubMedCrossRefGoogle Scholar
  28. 28.
    Bogazzi F, Lombardi M, Cosci C, et al. Identifiaction, treatment and management of cardiovascular risks in patients with acromegaly. Exp Rev Endocrinol Metab 2008, 3: 603–14.CrossRefGoogle Scholar
  29. 29.
    Giustina A, Casanueva FF, Cavagnini F, et al; Pituitary Society and the European Neuroendocrine Association. Diagnosis and treatment of acromegaly complications. J Endocrinol Invest 2003, 26: 1242–7.PubMedCrossRefGoogle Scholar
  30. 30.
    De Marinis L, Bianchi A, Mazziotti G, et al. The long-term cardiovascular out come of different GH-lowering treatments in acromegaly. Pituitary 2008, 11: 13–20.PubMedCrossRefGoogle Scholar
  31. 31.
    Rickers C, Wilke NM, Jerosch-Herold M, et al. Utility of cardiac magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Circulation 2005, 112: 855–61.PubMedCrossRefGoogle Scholar
  32. 32.
    Macedo R, Schmidt A, Rochitte CE, Lima JA, Bluemke DA. MRI to assess arrhythmia and cardiomyopathies: relationship to echocardiography. Echocadiography 2007, 24: 194–206.CrossRefGoogle Scholar
  33. 33.
    Nagueh SF, Mahmarian JJ. Noninvasive cardiac imaging in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2006, 48: 2410–22.PubMedCrossRefGoogle Scholar
  34. 34.
    Devlin AM, Moore NR, Ostman-Smith I. A comparison of MRI and echocardiography in hypertrophic cardiomyopathy. Br J Radiol 1999, 72: 258–64.PubMedGoogle Scholar
  35. 35.
    Moon JC, Fisher NG, McKenna WJ, Pennell DJ. Detection of apical hypertrophyc cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography. Heart 2004, 90: 645–9.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2010

Authors and Affiliations

  • F. Bogazzi
    • 1
  • M. Lombardi
    • 2
  • E. Strata
    • 2
  • G. Aquaro
    • 2
  • M. Lombardi
    • 1
  • C. Urbani
    • 1
  • V. Di Bello
    • 3
  • C. Cosci
    • 1
  • C. Sardella
    • 1
  • E. Talini
    • 3
  • E. Martino
    • 1
  1. 1.Department of Endocrinology and MetabolismUniversity of PisaPisaItaly
  2. 2.Laboratory of Magnetic ResonanceInstitute of Clinical Physiology, National Research CouncilPisaItaly
  3. 3.Cardio-Thoracic DepartmentUniversity of PisaPisaItaly

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