Terzolo M, Avonto L, Matrella C, Pozzi R, Luceri S, Borretta G, Pecchio F, Ugliengo G, Magro G P, Reimondo G
Dipartimento di Scienze Cliniche e Biologiche, Universit¿a di Torino, Italy.
J Endocrinol Invest. 1995 Sep;18(8):613-20. doi: 10.1007/BF03349779.
Cardiovascular problems have long been recognized as responsible for an increased morbidity and mortality in patients with acromegaly. The aim of the present study was to evaluate echocardiographically the prevalence of cardiomyopathy in a cohort of acromegalic patients and to analyze the results in relation to demographic, clinical and hormonal data. This study, a retrospective controlled clinical trial, was performed in 25 acromegalic patients, 12 men and 13 women aged 26-66 years (mean: 52.6). Fifteen patients had an active disease, 10 were cured by previous pituitary surgery. The same echocardiographic parameters were analyzed in 50 healthy subjects aged 30-70 years (mean: 51.4). Serum GH was determined on at least 4 samples drawn over 24 hours and plasma IGF-I on a single point. Standardized parameters of diastolic and systolic function were evaluated by real-time Doppler echocardiography. Twelve patients with active acromegaly underwent also 48-hour ECG registering. Left ventricular (LV) hypertrophy was found in 14/25 patients (56%). No difference was found between patients with active disease (53%) and patients with cured acromegaly (60%). LV mass index was significantly increased in acromegalics in comparison with healthy subjects (137 +/- 43 g/m2 vs 96 +/- 16 g/m2, p < 0.01) and also the indices of LV diastolic function were significantly impaired. Asymmetric septal hypertrophy was found only in one patient. Hypertension was detected in 9/25 patients (36%) without difference between patients with active or cured disease (40% vs 30%, NS). No significant correlation was found between hormonal or clinical data and echocardiographic findings. During Holter monitoring, heart rate of acromegalics was not significantly different from that of controls (78 +/- 12 bpm vs 72 +/- 10 bpm, NS) and only isolated supraventricular or ventricular premature complexes (Lown class 1) were detected. In conclusion, this study provides evidence of subclinical LV dysfunction in acromegaly in the absence of other known causes of heart disease and no significant difference in echocardiographic pattern was apparent between active or cured acromegalics.
心血管问题长期以来一直被认为是肢端肥大症患者发病率和死亡率增加的原因。本研究的目的是通过超声心动图评估一组肢端肥大症患者中心肌病的患病率，并分析其结果与人口统计学、临床和激素数据之间的关系。本研究为一项回顾性对照临床试验，对25例肢端肥大症患者进行了研究，其中男性12例，女性13例，年龄在26 - 66岁之间（平均：52.6岁）。15例患者疾病处于活动期，10例患者此前接受垂体手术已治愈。对50例年龄在30 - 70岁之间（平均：51.4岁）的健康受试者进行了相同的超声心动图参数分析。在24小时内至少采集4份样本测定血清生长激素（GH），单点测定血浆胰岛素样生长因子 - I（IGF - I）。通过实时多普勒超声心动图评估舒张和收缩功能的标准化参数。12例疾病处于活动期的肢端肥大症患者还进行了48小时心电图记录。25例患者中有14例（56%）发现左心室（LV）肥厚。疾病处于活动期的患者（53%）与肢端肥大症已治愈的患者（60%）之间未发现差异。与健康受试者相比，肢端肥大症患者的左心室质量指数显著升高（137±43 g/m² 对 96±16 g/m²，p < 0.01），左心室舒张功能指标也显著受损。仅1例患者发现不对称性室间隔肥厚。25例患者中有9例（36%）检测到高血压，疾病处于活动期或已治愈的患者之间无差异（40%对30%，无显著性差异）。未发现激素或临床数据与超声心动图结果之间存在显著相关性。在动态心电图监测期间，肢端肥大症患者的心率与对照组无显著差异（78±12次/分钟对72±10次/分钟，无显著性差异），仅检测到孤立的室上性或室性早搏（洛恩1级）。总之，本研究提供了证据，表明在无其他已知心脏病病因的情况下，肢端肥大症患者存在亚临床左心室功能障碍，疾病处于活动期或已治愈的肢端肥大症患者在超声心动图表现上无明显差异。
