Leclercq F, Fille A, Albat B, Beigbeder J Y, Messner P, Thévenet A, Bringer J, Grolleau R
Service de Cardiologie, Hôpital Saint-Eloi, Montpellier.
Ann Cardiol Angeiol (Paris). 1993 Mar;42(3):151-4.
Dilated cardiomyopathy associated with acromegaly is rare, but may improve with octreotide, a somatostatin analogue. The authors give the first description here of paradoxical worsening in cardiac function during such treatment, with the onset of episodes of acute decompensation following each attempt at starting treatment. Thus worsening was confirmed objectively by a challenge test with octreotide: increased dyspnea, fall in shortening fraction and in echocardiographic cardiac output (of 17 to 14% and 4 to 3 l/min respectively), a decrease in isotopic ejection fraction from 15 to 6% and this in parallel with efficacy regarding hormone levels of GH and IGF1 and a reduction in tumour size by CT scan. No further episode of decompensation occurred after treatment was stopped permanently. The patient underwent a transplant 3 months later. Suppression of the positive inotropic effect of GH by octreotide, associated with an increase in peripheral resistance is suggested. A negative inotropic effect of this hormonal analogue on too advanced a case of heart disease is also a possibility.
与肢端肥大症相关的扩张型心肌病较为罕见，但使用生长抑素类似物奥曲肽治疗可能会有所改善。本文作者首次描述了在这种治疗过程中心脏功能出现矛盾性恶化的情况，每次尝试开始治疗后都会出现急性失代偿发作。通过奥曲肽激发试验客观证实了这种恶化：呼吸困难加重、缩短分数和超声心动图心输出量下降（分别从17%降至14%和从4升/分钟降至3升/分钟）、同位素射血分数从15%降至6%，同时在生长激素（GH）和胰岛素样生长因子1（IGF1）激素水平方面有疗效，且通过CT扫描肿瘤大小缩小。永久停止治疗后未再发生失代偿发作。3个月后患者接受了移植。提示奥曲肽抑制了GH的正性肌力作用，并伴有外周阻力增加。这种激素类似物对病情过于严重的心脏病病例产生负性肌力作用也有可能。
