Vol 71, No 3 (2020)
Original paper
Published online: 2020-04-15
Subclinical left ventricular systolic dysfunction in patients with naive acromegaly — assessment with two-dimensional speckle-tracking echocardiography: retrospective study
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Abstract
Introduction: The aim of the study was to evaluate global longitudinal strain (GLS) in patients with naive acromegaly with normal left ventricular (LV) ejection fraction (EF).
Material and methods: Forty-three consecutive patients with naive acromegaly with normal LV systolic function as measured by EF, examined from 2008 to 2016, and 52 patients of a control group matched for age and sex underwent two-dimensional speckle-tracking echocardiography to assess GLS.
Results: The median GLS was significantly lower in the acromegaly group than in the control group (in %, –16.6 vs. –20.7; p < 0.01). The majority of acromegalic patients (n = 26; 60.5%) had abnormal GLS. Patients with impairment in GLS had a longer median duration of acromegaly symptoms (in years, 10.0 vs. 5.0; p < 0.05) and greater LV thickness (posterior wall in mm, 12.5 vs. 12.0; p < 0.05) compared to those with normal GLS. Patients with abnormal GLS had higher IGF-1 concentration, but without statistical significance. Diabetes mellitus and arterial hypertension, which are more common in acromegaly, were not significant determinants of abnormal GLS. The mean left ventricular mass index (LVMI) was increased in the acromegaly group compared to controls (in g/m2, 136 vs. 97; p < 0.01). There was
a significant negative correlation between LVMI and GLS (R = –0.47; p < 0.01).
Conclusions: Naive acromegalic patients presented abnormal GLS, which indicates subclinical systolic dysfunction in these patients. It has not been proven that arterial hypertension and diabetes mellitus are significant determinants of abnormal GLS.
Keywords: acromegalyglobal longitudinal strainleft ventricular systolic dysfunctionspeckle tracking echocardiographyleft ventricular ejection fractioninsulin growth factor-1growth hormone
References
- Bolanowski M, Ruchała M, Zgliczyński W, et al. Diagnostics and treatment of acromegaly — updated recommendations of the Polish Society of Endocrinology. Endokrynol Pol. 2019; 70(1): 2–18.
- Stelmachowska-Banaś M, Głogowski M, Vasiljevic A, et al. Ectopic acromegaly due to growth hormone-releasing hormone secretion from bronchial carcinoid causing somatotroph hyperplasia and partial pituitary insufficiency. Pol Arch Intern Med. 2019; 129(3): 208–210.
- Vilar L, Vilar CF, Lyra R, et al. Acromegaly: clinical features at diagnosis. Pituitary. 2017; 20(1): 22–32.
- Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37(27): 2129–2200.
- Tops LF, Delgado V, Marsan NA, et al. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail. 2017; 19(3): 307–313.
- Varghese MJ, Sharma G, Shukla G, et al. Longitudinal ventricular systolic dysfunction in patients with very severe obstructive sleep apnea: A case control study using speckle tracking imaging. Indian Heart J. 2017; 69(3): 305–310.
- Uziębło-Życzkowska B, Krzesinński P, Witek P, et al. Cushing's Disease: Subclinical Left Ventricular Systolic and Diastolic Dysfunction Revealed by Speckle Tracking Echocardiography and Tissue Doppler Imaging. Front Endocrinol (Lausanne). 2017; 8: 222.
- Geyer H, Caracciolo G, Abe H, et al. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr. 2010; 23(4): 351–69; quiz 453.
- Volschan ICM, Kasuki L, Silva CMS, et al. Two-dimensional speckle tracking echocardiography demonstrates no effect of active acromegaly on left ventricular strain. Pituitary. 2017; 20(3): 349–357.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
- Gunasekaran P, Panaich S, Briasoulis A, et al. Incremental Value of Two Dimensional Speckle Tracking Echocardiography in the Functional Assessment and Characterization of Subclinical Left Ventricular Dysfunction. Curr Cardiol Rev. 2017; 13(1): 32–40.
- Stampehl MR, Mann DL, Nguyen JS, et al. Speckle strain echocardiography predicts outcome in patients with heart failure with both depressed and preserved left ventricular ejection fraction. Echocardiography. 2015; 32(1): 71–78.
- Smiseth OA, Torp H, Opdahl A, et al. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016; 37(15): 1196–1207.
- Tykarski A, Narkiewicz K, Gaciong Z, et al. 2015 guidelines for the management of hypertension. Recommendations of the Polish Society of Hypertension - short version. Kardiol Pol. 2015; 73(8): 676–700.
- Araszkiewicz A, et al. Bandurska-Stankiewicz, E, Budzyński A, A position of Diabetes Poland. 2018 Guidelines on the management of diabetic patients. Clin Diabetol. 2018; 7: 1–90.
- Belghitia H, Brette S, Lafitte S, et al. Automated function imaging: a new operator-independent strain method for assessing left ventricular function. Arch Cardiovasc Dis. 2008; 101(3): 163–169.
- Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57(6): 450–458.
- Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4): 277–314.
- Cole GD, Dhutia NM, Shun-Shin MJ, et al. Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation. Int J Cardiovasc Imaging. 2015; 31(7): 1303–1314.
- Popielarz-Grygalewicz A, Gąsior JS, Konwicka A, et al. Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease. Int J Endocrinol. 2018; 2018: 6935054.
- Fung MJ, Thomas L, Leung DY, et al. Left ventricular function and contractile reserve in patients with hypertension. Eur Heart J Cardiovasc Imaging. 2018; 19(11): 1253–1259.
- Wang Q, Tan K, Xia H, et al. Left ventricular structural alterations are accompanied by subclinical systolic dysfunction in type 2 diabetes mellitus patients with concomitant hyperlipidemia: An analysis based on 3D speckle tracking echocardiography. Echocardiography. 2018; 35(7): 965–974.
- Crea F, Camici PG, Bairey Merz CN. Coronary microvascular dysfunction: an update. Eur Heart J. 2014; 35(17): 1101–1111.
- Antony I, Nitenberg A, Foult JM, et al. Coronary vasodilator reserve in untreated and treated hypertensove patients with and without left ventricular hypertrophy. J Am Coll Cardiol. 1993; 22(2): 514–520.
- Rizzoni D, Palombo C, Porteri E, et al. Relationships between coronary flow vasodilator capacity and small artery remodelling in hypertensive patients. J Hypertens. 2003; 21(3): 625–631.
- Nitenberg A, Valensi P, Sachs R, et al. Impairment of coronary vascular reserve and ACh-induced coronary vasodilation in diabetic patients with angiographically normal coronary arteries and normal left ventricular systolic function. Diabetes. 1993; 42(7): 1017–1025.
- Bach LA. Endothelial cells and the IGF system. J Mol Endocrinol. 2015; 54(1): R1–13.
- Holly JMP, Perks CM. Insulin-like growth factor physiology: what we have learned from human studies. Endocrinol Metab Clin North Am. 2012; 41(2): 249–63, v.
- Filus A, Zdrojewicz Z. [Insulin-like growth factor-1 (IGF-1) — structure and the role in the human body]. Pediatr Endocrinol Diabetes Metab. 2015; 20(4): 161–169.
- Muniyappa R, Walsh MF, Rangi JS, et al. Insulin like growth factor 1 increases vascular smooth muscle nitric oxide production. Life Sci. 1997; 61(9): 925–931.
- Clemmons DR. Modifying IGF1 activity: an approach to treat endocrine disorders, atherosclerosis and cancer. Nat Rev Drug Discov. 2007; 6(10): 821–833.
- Higashi Y, Sukhanov S, Anwar A, et al. Aging, atherosclerosis, and IGF-1. J Gerontol A Biol Sci Med Sci. 2012; 67(6): 626–639.
- Thum T, Hoeber S, Froese S, et al. Age-dependent impairment of endothelial progenitor cells is corrected by growth-hormone-mediated increase of insulin-like growth-factor-1. Circ Res. 2007; 100(3): 434–443.
- Tellatin S, Maffei P, Osto E, et al. Coronary microvascular dysfunction may be related to IGF-1 in acromegalic patients and can be restored by therapy. Atherosclerosis. 2018; 269: 100–105.
- Anagnostis P, Efstathiadou ZA, Gougoura S, et al. Oxidative stress and reduced antioxidative status, along with endothelial dysfunction in acromegaly. Horm Metab Res. 2013; 45(4): 314–318.
