Early detection of myocardial involvement by strain doppler echocardiography in patients with acromegaly

Abstract

Background: A considerable literature suggests that there is a specific cardiomyopathy in acromegaly, resulting in structural and functional abnormalities that may be partially reversed by effective reduction in growth hormone / insulin-like growth factor I (GH/IGF-I) levels. Recent reports suggest that structural changes can occur after short-term exposure to GH. The aim of our study was the early detection of subclinical cardiac involvement in patients with acromegalia using tissue Doppler (TDI) and strain Doppler (SR) imaging. Methods: Thirty-nine patients with acromegalia underwent physical examination, electrocardiogram, and standard transthoracic echocardiogram in order to exclude those with cardiac involvement. The remaining twenty-seven patients without clinical and echocardiographic cardiac involvement (group 1, age 51±13 years, 16 females) were compared to 24 sex and age-matched controls (group 2, age 49±12 years, 11 females). Left and right ventricular ejection fraction (LVEF, RVEF), fractional shortening (LVFS, RVFS), and mitral and tricuspid flow filling parameters (MV and TV E/A ratio, MV and TV DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software (Aplio, Toshiba Corp.). Velocity and strain traces from left and right ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed from the same wall site in the apical 4-chamber view. Systolic (Sw) and diastolic (Ew, Aw) wall velocities as well as peak systolic strain (ε) and systolic and diastolic (isovolumic, early and late diastolic) SR values (SR-S, SR-IVR, SR-E, SR-A) were determined. Results: Dimensions of left and right atrial and ventricular chambers were similar between the two groups. No significant differences were determined between the two groups for the following parameters: LVEF, RVEF, LVFS, RVFS, MV and TV E/A ratio, MV and TV DT. A significant difference was found between the two groups for MV and TV Ew/Aw ratio at basal level (p<0.001 and p<0.05, respectively). Left and right ventricular peak systolic ε and systolic and early diastolic SR values were significantly reduced compared to controls at basal (p<0.001) and mid-cavity level (p<0.005) but not at apical level. Conclusion: In patients with acromegaly TDI/SR parameters (mainly from basal ventricular segments) can show a possible early cardiac involvement not detected by conventional echocardiography.