Hradec J, Marek J, Kral J, Janota T, Poloniecki J, Malik M
Third Department of Medicine, Charles University, Prague, Czech Republic.
Am J Cardiol. 1993 Jul 15;72(2):205-10. doi: 10.1016/0002-9149(93)90161-5.
Heart muscle disease in acromegaly manifests usually as cardiac hypertrophy. Based on a retrospective analysis, it was suggested that cardiac hypertrophy is slowly reversible after normalization of plasma growth hormone levels. The reversibility of acromegalic heart muscle disease during and after treatment of acromegaly was studied prospectively. A cohort of 78 patients was examined echocardiographically in 1981, and 38 survivors of this group were reexamined 10 years later. Patients were classified according to original hormonal activity in 1981, and change in hormonal activity during follow-up into the following 4 groups: group I--hormonally inactive for entire follow-up (n = 10); group II--hormonally active for entire follow-up (n = 11); group III--initially hormonally inactive with later resurgence (n = 6); and group IV--initially hormonally active with later normalization of growth hormone levels (n = 11). No significant echocardiographic changes occurred during follow-up in group I. Left ventricular posterior wall and septal diastolic thickness, and left ventricular mass increased significantly (all p < 0.05) in group II. Left ventricular posterior wall thickness, mass and diastolic volume increased significantly (p < 0.05, < 0.01 and < 0.001, respectively) in group III. On the contrary, there were significant decreases in left ventricular mass, and both diastolic and systolic left ventricular volumes (p < 0.01, < 0.05 and < 0.05, respectively) in group IV. It is concluded that both hypertrophy and dilatation of the left ventricle in acromegaly are slowly reversible after successful treatment. On the contrary, continuing or relapsed hyperproduction of growth hormone causes further deterioration of acromegalic heart disease.
肢端肥大症中的心肌疾病通常表现为心脏肥大。基于一项回顾性分析，有人提出血浆生长激素水平恢复正常后，心脏肥大可缓慢逆转。对肢端肥大症治疗期间及治疗后的心肌疾病可逆性进行了前瞻性研究。1981年对78例患者进行了超声心动图检查，该组中的38名幸存者在10年后接受了复查。根据1981年的原始激素活性以及随访期间激素活性的变化，将患者分为以下4组：第一组——整个随访期间激素无活性（n = 10）；第二组——整个随访期间激素有活性（n = 11）；第三组——最初激素无活性，后来复发（n = 6）；第四组——最初激素有活性，后来生长激素水平恢复正常（n = 11）。第一组在随访期间未发生明显的超声心动图变化。第二组的左心室后壁和室间隔舒张期厚度以及左心室质量显著增加（均p < 0.05）。第三组的左心室后壁厚度、质量和舒张期容积显著增加（分别为p < 0.05、< 0.01和< 0.001）。相反，第四组的左心室质量以及左心室舒张期和收缩期容积均显著下降（分别为p < 0.01、< 0.05和< 0.05）。结论是，成功治疗后，肢端肥大症患者左心室的肥大和扩张均可缓慢逆转。相反，生长激素持续过量分泌或复发会导致肢端肥大性心脏病进一步恶化。
