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Effects of long-term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance in acromegaly

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Abstract

To date, no data are available on the effects of long-term combined treatment with somatostatin analogues (SA) and pegvisomant (PEG) on cardiovascular complications in acromegaly. The current study aimed at investigating the effects of long-term SA + PEG on cardiac structure and performance. Thirty-six patients (14 M, 22 F, aged 52.3 ± 10.2 years) entered this study. Weight, BMI, systolic (SBP) and diastolic (DBP) blood pressure, IGF-I, fasting glucose (FG), fasting insulin (FI), HOMA-IR, HbA1c, and lipids were evaluated at baseline (T0), after long-term (median 36 months) SA (T1), after 12 (T12) and 60 (T60) months of SA + PEG, and at last follow-up (LFU, median 78 months). At each time point, all patients underwent echocardiography. At T1, induced a slight but not significant decrease in IGF-I (p = 0.077), whereas FI (p = 0.004), HOMA-IR (p = 0.013), ejection fraction (EF, p = 0.013), early (E) to late (A) ventricular filling velocities (E/A, p = 0.001), and isovolumetric relaxation time (IVRT, p = 0.000) significantly improved. At T12, IGF-I (p = 0.000) significantly reduced compared to T0, and FI (p = 0.001), HOMA-IR (p = 0.000), LVMI (p = 0.000), and E/A (p = 0.006) further improved compared to T1. At T60, FI (p = 0.027), HOMA-IR (p = 0.049), and E/A (p = 0.005) significantly improved as compared to T1. At LFU IGF-I normalized in 83.3 %, FI (p = 0.000), HOMA-IR (p = 0.000), LVMi (p = 0.000), and E/A (p = 0.005) further improved as compared to T1. PEG dose significantly correlated with LVMi at T12 (r = 0.575, p = 0.000) and T60 (r = 0.403, p = 0.037). Long-term PEG addition to SA improves cardiac structure and performance, particularly diastolic dysfunction, in acromegalic patients resistant to SA.

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Authors and Affiliations

  1. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II, via S. Pansini 5, 80131, Naples, Italy

    Renata S. Auriemma, Ludovica F. S. Grasso, Mariano Galdiero, Claudia Pivonello, Chiara Simeoli, Maria Cristina De Martino, Rosario Ferrigno, Mariarosaria Negri, Cristina de Angelis, Rosario Pivonello & Annamaria Colao

  2. Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy

    Maurizio Galderisi

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  1. Renata S. Auriemma
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  2. Ludovica F. S. Grasso
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  3. Mariano Galdiero
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  4. Maurizio Galderisi
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  5. Claudia Pivonello
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  12. Annamaria Colao
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Correspondence to Rosario Pivonello.

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Conflict of interest

AC has been principal investigator of research studies from Novartis, Ipsen, Pfizer, and Lilly; has received research grants from Ferring, Lilly, Ipsen, Merck-Serono, Novartis, Novo-Nordisk, and Pfizer; has been occasional consultant for Novartis, Ipsen, and Pfizer; and has received fees and honoraria from Ipsen, Novartis, and Pfizer. RP has been principal investigator of research studies from Novartis; has received research grants from Novartis, Pfizer, Viropharma, and IBSA; has been occasional consultant for Novartis, Ipsen, Pfizer, Viropharma, Ferring, and Italfarmaco; and received fees and honoraria for presentations from Novartis. RSA has been occasional consultant for Novartis and has received fees and honoraria from Novartis. LFSG, MGaldiero, MGalderisi, CP, CS, MCDM, RF MN, and CdA have nothing to disclose.

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Auriemma, R.S., Grasso, L.F.S., Galdiero, M. et al. Effects of long-term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance in acromegaly. Endocrine 55, 872–884 (2017). https://doi.org/10.1007/s12020-016-0995-5

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