López-Velasco R, Escobar-Morreale H F, Vega B, Villa E, Sancho J M, Moya-Mur J L, García-Robles R
Department of Endocrinology, Hospital Ramón y Cajal, Madrid, Spain.
J Clin Endocrinol Metab. 1997 Apr;82(4):1047-53. doi: 10.1210/jcem.82.4.3876.
To evaluate the relative contributions of past or present GH hypersecretion and of hypertension to the cardiac abnormalities present in acromegaly, we have studied the serum GH and insulin-like growth factor I concentrations, systolic and diastolic blood pressures, and morphological and functional cardiac indexes as measured by echocardiography-Doppler, in 39 patients with active or cured acromegaly, 16 hypertensive controls, and 17 normotensive controls. Hypertension was present in 42.8% of patients with active acromegaly and in 28.0% of patients in which acromegaly was cured. Hypertension was independently related to an increase in indexes of cardiac morphology (left ventricular mass, left ventricular posterior wall thickness, interventricular septum thickness, relative wall thickness with respect to the diastolic diameter of the left ventricle, and left atrial end-systolic diameter), systolic function (stroke volume, fractional shortening, and end-systolic stress), and diastolic function (isovolumic relaxation time and maximal late diastolic flow velocity) and to a reduction in the early to late maximal diastolic flow velocity ratio. Acromegaly was related to an increase in left ventricular mass, stroke volume, cardiac output, and isovolumic relaxation time, which were independent from the presence of hypertension. End-systolic stress was reduced by acromegaly. In the five patients in which active acromegaly was successfully treated, left ventricular mass and left ventricular posterior wall thickness were reduced 1 yr later. In conclusion, the asymptomatic morphological and functional cardiac abnormalities present in acromegalic patients are independently related to acromegaly and hypertension, pointing to the existence to a specific acromegalic myocardiopathy that might be aggravated by the coexistence of hypertension.
为评估既往或当前生长激素分泌过多及高血压对肢端肥大症患者心脏异常的相对影响，我们研究了39例活动期或治愈期肢端肥大症患者、16例高血压对照者及17例血压正常对照者的血清生长激素和胰岛素样生长因子I浓度、收缩压和舒张压，以及通过超声心动图-多普勒测量的形态学和功能性心脏指标。活动期肢端肥大症患者中42.8%存在高血压，治愈期肢端肥大症患者中28.0%存在高血压。高血压与心脏形态学指标（左心室质量、左心室后壁厚度、室间隔厚度、相对于左心室舒张直径的相对壁厚度以及左心房收缩末期直径）、收缩功能（每搏输出量、缩短分数和收缩末期应力）和舒张功能（等容舒张时间和最大舒张晚期流速）增加以及舒张早期与晚期最大流速比值降低独立相关。肢端肥大症与左心室质量、每搏输出量、心输出量和等容舒张时间增加相关，这些与高血压的存在无关。肢端肥大症使收缩末期应力降低。在5例活动期肢端肥大症得到成功治疗的患者中，1年后左心室质量和左心室后壁厚度降低。总之，肢端肥大症患者存在的无症状形态学和功能性心脏异常与肢端肥大症和高血压独立相关，表明存在一种特定的肢端肥大性心肌病，高血压并存可能会使其加重。
