Prevalence of Symptomatic Cardiopathy in Acromegaly: Experience of a Tertiary Health Center

Presentation Number: SUN 445
Date of Presentation: April 2nd, 2017

Vânia Balderrama Brondani*1, Lara Bessa Campelo Pinheiro Cavalcante2, Lygia Leal Freitas de Almendra3, Alexandre BC Souza4, Felipe HG Duarte5, Raquel S Jallad6 and Marcello D Bronstein7
1Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, BRAZIL, 2Faculdade de Medicina da Universidade de São Paulo, São Paulo, 3Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, 4Faculdade de Medicina da Universidade de São Paulo, Brazil, 5Unidade de Neuroendocrinologia, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, HC-FMUSP, Sao Paulo, Brazil, 6Unidade de Neuroendocrinologia, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, HC-FMUSP, São Paulo, Brasil, Sao Paulo SP, Brazil, 7Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Abstract

Introduction: Acromegaly is a chronic disease characterized by GH and IGF-1 increased levels. The presence of comorbidities as diabetes, hypertension, insulin resistance and cardiomyopathy leads to an increased cardiovascular risk. The aim of this study is to evaluate the presence of heart disease in a cohort of patients of a specialized tertiary center.

Patients and Methods: Medical records including clinical, laboratorial and cardiologic assessments of 350 acromegalic patients followed in our center were retrospectively evaluated. Statistical analysis (Mann Whitney and Spearman test) were done to test the association between GH/IGF-1 levels and cardiovascular complications.

Results: Forty-eight patients (14% of the cohort, 36 males), median age: 45.5 years (range:14-81years) and median body surface area 2.1 m2 (1.6-2.71 m2)  were diagnosed with symptomatic heart disease. Twenty-four of them (50%) were referred to us by cardiologists , all with active disease. In the remaining r 24 patients, heart disease was diagnosed during the course of acromegaly follow-up, 22 of them still with active disease despite treatment.. At baseline, mean basal hormone levels were: GH: 24.9 (1.5-1261 ng/mL), IGF-1: 905 (425-1932 ng/mL) and xULNR (IGF-1: times above upper limit of the normal range): 3.7 (1.3-13). At admission, 48% presented some cardiac manifestation (dyspnea during effort, palpitation, chest pain and/or peripheral edema), 82% had hypertension, 54% diabetes mellitus. Seven patients were diagnosed with coronary artery disease (CAD), 60% (4/7) showed decreased ejection fraction (EF) and all of them presented increased left ventricular mass index (LVMI). Forty-one patients presented with cardiopathy not related to coronary disease: increased LVMI was present in 83% of the cases [mean volume, females: 178.8 g/m² (normal: <96 g/m²), males 197.7g/m² (normal: < 116 g/m²)], 41% presented with decreased EF [mean: 0.51(female) and 0.49 (male) (normal: > 0,55)], 73% presented congestive heart failure, 24% showed some degree of valvopathy and 24% exhibited ventricular hypokinesia. A strong association was found between IGF-1 levels and LVMI (p=0.007). During follow up eleven patients deceased due to cardiovascular disease.

Conclusion: Cardiovascular complications are the main cause of death in acromegaly patients. In our cohort 13% presented with symptomatic heart disease. Specialized cardiologic assessment is advised for all patients at diagnosis and during follow-up.

 

Nothing to Disclose: VBB, LBCPC, LLFDA, ABS, FHD, RSJ, MDB