Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey.
Hormones (Athens). 2024 Dec;23(4):777-788. doi: 10.1007/s42000-024-00558-7. Epub 2024 Apr 18.
In patients with acromegaly, the long-term presence of elevated GH and IGF-1 levels is associated with an unfavorable cardiovascular risk profile. We aimed to assess the relationship of four-dimensional speckle tracking echocardiographic (4DSTE) measurements with growth differentiation factor-15 (GDF-15) levels and the Framingham Cardiovascular Risk Score (FRS) in patients with acromegaly.
A single-center, cross-sectional study was conducted. The study included 40 acromegaly and 32 age- and gender-matched controls. Anthropometric, biochemical, and echocardiographic assessments were performed. GDF-15 levels were measured using ELISA.
In the controlled acromegaly group, global longitudinal (GLS), circumferential (GCS), area (GAS), and radial (GRS) strain measurements identified by 4DSTE were lower than those of the controls (p < 0.05). Moreover, strain parameters were lower in active acromegaly patients than in controls, but the difference was not statistically significant. The GLS was negatively correlated with age, the estimated disease duration, and FRS. Serum GDF-15 levels showed no significant difference between the acromegaly and control groups. In patients with acromegaly, serum GDF-15 levels were positively correlated with age, waist-to-hip ratio, systolic and diastolic blood pressure, FRS, fasting plasma glucose, and HbA1c, but not with strain parameters. The multiple regression analysis revealed that FRS was an independent factor associated with serum GDF-15 levels in patients with acromegaly and the overall cohort (p < 0.001).
Our study demonstrates that while LVEF was within normal limits, global strain parameters (GLS, GCS, GAS, and GRS) measured by using a novel imaging technique, 4DSTE, were lower in patients with acromegaly, suggesting the presence of subclinical systolic dysfunction in patients with acromegaly. GDF-15 can be a potential predictor of cardiovascular risk in patients with acromegaly.
在肢端肥大症患者中，长期升高的 GH 和 IGF-1 水平与不良心血管风险特征相关。我们旨在评估四维斑点追踪超声心动图（4DSTE）测量值与生长分化因子-15（GDF-15）水平和肢端肥大症患者的弗雷明汉心血管风险评分（FRS）之间的关系。
进行了一项单中心、横断面研究。该研究纳入了 40 例肢端肥大症患者和 32 例年龄和性别匹配的对照组。进行了人体测量、生化和超声心动图评估。使用 ELISA 测量 GDF-15 水平。
在对照肢端肥大症组中，4DSTE 测量的整体纵向应变（GLS）、周向应变（GCS）、面积应变（GAS）和径向应变（GRS）均低于对照组（p<0.05）。此外，活动期肢端肥大症患者的应变参数低于对照组，但差异无统计学意义。GLS 与年龄、估计的疾病持续时间和 FRS 呈负相关。肢端肥大症组和对照组之间的血清 GDF-15 水平无显著差异。在肢端肥大症患者中，血清 GDF-15 水平与年龄、腰臀比、收缩压和舒张压、FRS、空腹血糖和 HbA1c 呈正相关，但与应变参数无关。多元回归分析显示，FRS 是肢端肥大症患者和整个队列中与血清 GDF-15 水平相关的独立因素（p<0.001）。
我们的研究表明，尽管左心室射血分数（LVEF）在正常范围内，但使用新型成像技术 4DSTE 测量的整体应变参数（GLS、GCS、GAS 和 GRS）在肢端肥大症患者中较低，提示肢端肥大症患者存在亚临床收缩功能障碍。GDF-15 可能是肢端肥大症患者心血管风险的潜在预测因子。
