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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

Authors


Dr Annamaria Colao, Department of Molecular and Clinical Endocrinology and Oncology, ‘Federico II’ University, via S. Pansini 5, 80131 Napoli, Italy. Tel.: + 39 081 7462132; Fax: + 39 081 7463668; E-mail: colao@unina.it

Summary

background Cardiovascular disease is the most frequent cause of death of patients with acromegaly.

aim To investigate whether young patients with a presumed short disease duration are more likely to reverse the acromegalic cardiomyopathy than older patients with longer disease duration.

design An open prospective design.

patients Ten young (aged < 40 years), and 12 middle-aged (41–59 years) patients with active acromegaly well controlled after 12 months of treatment with the depot formulation of octreotide (OCT-LAR); 22 sex- and age-matched healthy subjects as controls.

methods Left ventricular (LV) mass (LVM) by echocardiography and performance by equilibrium radionuclide angiography were measured before and after 12 months of OCT-LAR treatment.

results At study entry, none of the controls and 14 patients (63·4%) of whom six were young (χ2 = 17·7; P < 0·0001) had LV hypertrophy (LVH); none of the controls and four patients of whom one was young had insufficient LV ejection fraction (LVEF) at rest (< 50%); one control and 13 patients (59·1%) of whom five were young (χ2 = 12·7; P < 0·0001) had inadequate LVEF at peak exercise (ΔLVEF; < 5% increase of baseline). After 12 months, no change in haemodynamic and diastolic parameters was observed in both groups, except for a significant decrease in heart rate at peak exercise in young patients (P < 0·0001). The LVM index decreased significantly in both young (124·4 ± 5·8 vs. 103·4 ± 3·9 g/m2; P = 0·01) and middle-aged patients (140·9 ± 7·9 vs. 117·8 ± 6·6 g/m2; P = 0·03). LVH disappeared in 10 of 14 patients (71·4%): all six young and four of eight middle-aged patients (50%). LVEF at rest and at peak exercise increased significantly in both groups but ΔLVEF increased significantly only in young patients (1·5 ± 2·9 vs. 13·7 ± 5·2%, P = 0·04); it normalized in nine of 13 patients (69·2%), four of five young (80%) and four of eight middle-aged patients (50%). Exercise capacity (82·5 ± 5·3 vs. 110·0 ± 5·5 W, P = 0·005) and duration (7·3 ± 0·3 vs. 9·9 ± 0·4 min, P = 0·0003) also increased only in young patients.

conclusions The acromegalic cardiomyopathy is reversed in most young patients with short disease duration and achieving disease control after OCT-LAR treatment for 12 months, indicating that early diagnosis and effective treatment are essential.

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