Abstract
BackgroundArterial hypertension (AH) that accompanies acromegaly (AC) may lead to cardiovascular dysfunction. Such consequences may be detected with impedance cardiography (ICG), which is a noninvasive method of hemodynamic assessment. Early detection of subclinical hemodynamic alterations in AC patients may be crucial for optimizing treatment and preventing cardiovascular remodeling. The purpose of this study was to identify the hemodynamic parameters of the cardiovascular system that differentiate patients with AC from those in the control group (CG), with a particular emphasis on potential targets for medical therapy.MethodsThis observational, prospective, clinical study involved a comparative analysis of 33 AC patients with no significant comorbidities and the controls selected via propensity score matching based on a set of baseline characteristics (age, sex, body mass index, mean blood pressure [MBP]), with comparable proportions of AH patients. The assessed hemodynamic parameters included the stroke volume index (SI), cardiac index, systemic vascular resistance index, velocity index (VI), acceleration index, Heather index (HI), and thoracic fluid content (TFC).ResultsBoth the AC group and the CG had well-controlled AH (mean blood pressure of 121/77 mmHg and 119/76 mmHg, respectively). In terms of baseline characteristics, the AC group was characterized by a higher hear rate and lower creatinine levels than the CG (76.2 bpm vs. 66.8 bpm [p = 0.001] and 0.755 mg/dL vs. 0.850 mg/dL [p = 0.035], respectively). ICG assessment of AC patients and CG patients showed the former to have higher heart rates (73.5 bpm vs. 65.2 bpm; p = 0.003), lower SI (43.8 mL/m2 vs. 53.4 mL/m2; p = 0.0001), lower VI (42.1 1/1000/s vs. 49.3 1/1000/s; p = 0.037), lower HI (8.49 Ohm/s2 vs. 13.4 Ohm/s2, p ≤ 0.0001), and higher thoracic fluid content (TFC) (38.4 1/kOhm vs. 28.1 1/kOhm; p ≤ 0.0001), respectively.ConclusionsEven with well-controlled hypertension, AC is associated with a high TFC, increased heart rate, and decreased indices of cardiac contractility. Hemodynamic changes in AC patients may be detected with the modern, noninvasive diagnostic tool, ICG.
Highlights
(AC) is a rare, chronic disease caused by a pituitary somatotropic adenoma secreting the growth hormone (GH)
This observational, prospective, clinical study involved a comparative analysis of 33 AC patients with no significant comorbidities and the controls selected via propensity score matching based on a set of baseline characteristics, with comparable proportions of arterial hypertension (AH) patients
Even with well-controlled hypertension, AC is associated with a high thoracic fluid content (TFC), increased heart rate, and decreased indices of cardiac contractility
Summary
(AC) is a rare, chronic disease caused by a pituitary somatotropic adenoma secreting the growth hormone (GH). The most common cardiovascular complications include cardiomyopathy (90%), with its consequent left ventricular (LV) dysfunction and heart failure (HF), and arterial hypertension (AH) (18%–60%) [7]. Because of the many pathological effects of hormonal excess in patients with AC, most of the routine diagnostic assessments of cardiovascular hemodynamics may be of somewhat limited use, due to our incomplete understanding of AC-associated pathophysiological processes. There is an ongoing search for novel noninvasive diagnostic methods that would help detect the abnormalities occurring early during the course of AC and increase the odds of using an optimal, targeted therapy, which would lower the cardiovascular risk. Arterial hypertension (AH) that accompanies acromegaly (AC) may lead to cardiovascular dysfunction. Such consequences may be detected with impedance cardiography (ICG), which is a noninvasive method of hemodynamic assessment. The purpose of this study was to identify the hemodynamic parameters of the cardiovascular system that differentiate patients with AC from those in the control group (CG), with a particular emphasis on potential targets for medical therapy
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