Abstract
Cardiovascular diseases, including ventricular arrhythmias are responsible for increased mortality in patients with acromegaly. Acromegaly may cause repolarization abnormalities such as QT prolongation and impairment of repolarization reserve enhancing liability to arrhythmia. The aim of this study was to determine the short-term beat-to-beat QT variability in patients with acromegaly. Thirty acromegalic patients (23 women and 7 men, mean age±SD: 55.7±10.4 years) were compared with age- and sex-matched volunteers (mean age 51.3±7.6 years). Cardiac repolarization parameters including frequency corrected QT interval, PQ and QRS intervals, duration of terminal part of T waves (Tpeak-Tend) and short-term variability of QT interval were evaluated. All acromegalic patients and controls underwent transthoracic echocardiographic examination. Autonomic function was assessed by means of five standard cardiovascular reflex tests. Comparison of the two groups revealed no significant differences in the conventional ECG parameters of repolarization (QT: 401.1±30.6 ms vs 389.3±16.5 ms, corrected QT interval: 430.1±18.6 ms vs 425.6±17.3 ms, QT dispersion: 38.2±13.2 ms vs 36.6±10.2 ms; acromegaly vs control, respectively). However, short-term beat-to-beat QT variability was significantly increased in acromegalic patients (4.23±1.03 ms vs 3.02±0.80, P<0.0001). There were significant differences between the two groups in the echocardiographic dimensions (left ventricular end diastolic diameter: 52.6±5.4 mm vs 48.0±3.9 mm, left ventricular end systolic diameter: 32.3±5.2 mm vs 29.1±4.4 mm, interventricular septum: 11.1±2.2 mm vs 8.8±0.7 mm, posterior wall of left ventricle: 10.8±1.4 mm vs 8.9±0.7 mm, P<0.05, respectively). Short-term beat-to-beat QT variability was elevated in patients with acromegaly in spite of unchanged conventional parameters of ventricular repolarization. This enhanced temporal QT variability may be an early indicator of increased liability to arrhythmia.
Highlights
Hypertension, left ventricular hypertrophy, asymmetric septal hypertrophy, cardiomyopathy, and congestive heart failure are well-known cardiovascular complications of acromegaly caused by pituitary tumors [1]
Significant differences were seen in serum human growth hormone (hGH) (P = 0.0028) and insulin-like growth factor-1 (IGF-1) (P = 0.0013) levels between acromegalic and control groups
There was no significant difference in nadir value of hGH during oral glucose tolerance test (OGTT) between active (3.40 ± 2.10 ng/ml) and inactive (1.80 ± 1.86 ng/ml) acromegalic subgroups
Summary
Hypertension, left ventricular hypertrophy, asymmetric septal hypertrophy, cardiomyopathy, and congestive heart failure are well-known cardiovascular complications of acromegaly caused by pituitary tumors [1]. Excessive secretion of growth hormone and IGF-1 can result in major structural and functional changes in cardiac system and arrhythmias, hypertension, and valvular heart disease are present in up to 60% of patients by the time of the diagnosis of acromegaly [1]. Clinical data suggest that a specific cardiomyopathy develops in acromegaly associated with life-threatening dysrhythmias [2]. Complex morphological and functional remodeling may be partially reversed by effective control of growth hormone and IGF-1 concentrations [2]. Acromegaly can be associated with cardiovascular diseases contributing to increased mortality among patients [1,2]. Effective control of acromegaly with pegvisomant, a GH receptor antagonist, led to a significant improvement of Framingham risk score, and reduced the likelihood for development of coronary heart diseases, too [3]
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