Section of Endocrinology, Department of Molecular and Clinical Endocrinology and Oncology, University Federico II of Naples, via S. Pansini 5, 80131 Naples, Italy.
Eur J Endocrinol. 2011 Nov;165(5):713-21. doi: 10.1530/EJE-11-0408. Epub 2011 Aug 25.
The most frequent cause of death in acromegaly is cardiomyopathy.
To evaluate determinants of acromegalic cardiomyopathy.
Observational, open, controlled, retrospective study.
Two hundred and five patients with newly diagnosed active acromegaly (108 women and 97 men; median age 44 years) and 410 non-acromegalic subjects sex- and age-matched with the patients.
Left ventricular (LV) mass index (LVMi), transmitral inflow early-to-atrial (E/A) peak velocity ratio, and LV ejection fraction (LVEF) were measured by Doppler echocardiography to determine the prevalence of LV hypertrophy (LVH), diastolic and systolic dysfunction. The role of age, estimated disease duration, body mass index, GH and IGF1 levels, systolic and diastolic blood pressure, lipid profile and glucose tolerance in determining different features of the acromegalic cardiomyopathy was investigated.
Compared with controls, the patients had lower E/A, LVEF, high-density lipoprotein (HDL)-cholesterol levels and higher LVMi, total- and low-density lipoprotein (LDL)-cholesterol, triglycerides, glucose and insulin levels, homeostatic model assessment of insulin resistance (HOMA-R) and HOMA-β. The relative risk to develop mild (odds ratio (OR)=1.67 (1.05-2.66); P=0.027) or severe hypertension (OR=1.58 (1.04-2.32); P=0.027), arrhythmias (OR=4.93 (1.74-15.9); P=0.001), impaired fasting glucose/impaired glucose tolerance (OR=2.65 (1.70-4.13); P<0.0001), diabetes (OR=2.14 (1.34-3.40); P=0.0009), LVH (OR=11.9 (7.4-19.5); P<0.0001), diastolic (OR=3.32 (2.09-5.31); P<0.0001) and systolic dysfunction (OR=14.2 (6.95-32.2); P<0.0001), was higher in acromegaly. The most important predictor of LVH (t=2.4, P=0.02) and systolic dysfunction (t=-2.77, P=0.006) was disease duration and that of diastolic dysfunction was patient's age (t=-3.3, P=0.001). Patients with an estimated disease duration of >10 years had a relative risk to present cardiac complications three times higher than patients with estimated disease duration ≤5 years.
The prevalence of different features of cardiomyopathy is 3.3-14.2 times higher in the acromegalic than in the non-acromegalic population. The major determinant of cardiomyopathy is disease duration.
肢端肥大症患者死亡的最常见原因是心肌病。
评估肢端肥大症性心肌病的决定因素。
观察性、开放、对照、回顾性研究。
205 例新诊断为活动性肢端肥大症的患者（108 名女性和 97 名男性；中位年龄 44 岁）和 410 名与患者性别和年龄匹配的非肢端肥大症患者。
通过多普勒超声心动图测量左心室（LV）质量指数（LVMi）、经二尖瓣流入道早期至心房（E/A）峰值速度比和 LV 射血分数（LVEF），以确定 LV 肥厚（LVH）、舒张和收缩功能障碍的发生率。研究了年龄、估计疾病持续时间、体重指数、GH 和 IGF1 水平、收缩压和舒张压、血脂谱和葡萄糖耐量在确定肢端肥大性心肌病不同特征中的作用。
与对照组相比，患者的 E/A、LVEF、高密度脂蛋白（HDL）-胆固醇水平较低，而 LVMi、总胆固醇和低密度脂蛋白（LDL）-胆固醇、甘油三酯、葡萄糖和胰岛素水平、稳态模型评估的胰岛素抵抗（HOMA-R）和 HOMA-β较高。发生轻度（比值比（OR）=1.67（1.05-2.66）；P=0.027）或重度高血压（OR=1.58（1.04-2.32）；P=0.027）、心律失常（OR=4.93（1.74-15.9）；P=0.001）、空腹血糖受损/糖耐量受损（OR=2.65（1.70-4.13）；P<0.0001）、糖尿病（OR=2.14（1.34-3.40）；P=0.0009）、LVH（OR=11.9（7.4-19.5）；P<0.0001）、舒张功能障碍（OR=3.32（2.09-5.31）；P<0.0001）和收缩功能障碍（OR=14.2（6.95-32.2）；P<0.0001）的可能性在肢端肥大症患者中要高出 3.3-14.2 倍。LVH（t=2.4，P=0.02）和收缩功能障碍（t=-2.77，P=0.006）的最重要预测因素是疾病持续时间，而舒张功能障碍的预测因素是患者年龄（t=-3.3，P=0.001）。估计疾病持续时间>10 年的患者发生心脏并发症的相对风险是估计疾病持续时间≤5 年的患者的三倍。
肢端肥大症患者出现不同程度心肌病的概率是未患肢端肥大症患者的 3.3-14.2 倍。心肌病的主要决定因素是疾病持续时间。
