Reversibility of Cardiac Involvement in Acromegaly Patients After Surgery: 12-Month Follow-up Using Cardiovascular Magnetic Resonance.

Xiaopeng Guo,Xiao Li,Yihan Cao,Jian Cao,Yining Wang,Xinjie Bao,Lu Gao,Peijun Liu,Zihao Wang,Bing Xing

doi:10.3389/fendo.2020.598948

Abstract

PurposeCardiac comorbidity is one of the leading causes of death among acromegaly patients. We aimed to investigate the reversibility of acromegalic cardiac involvement after surgical treatment using the gold standard method, cardiovascular magnetic resonance, and to explore the effects of endocrine remission and gender on reversibility.MethodsIn this single-center, prospective cohort study, fifty untreated acromegaly patients were enrolled. Comprehensive cardiac assessments were performed using a 3.0 T magnetic resonance scanner before and 3 and 12 months after transsphenoidal adenomectomy.ResultsPreoperatively, left ventricular (LV) enlargement (13.0%), LV systolic dysfunction (6.5%), right ventricular (RV) enlargement (4.3%), RV systolic dysfunction (2.2%) and myocardial fibrosis (12.0%) were identified. On average, the LV and RV ejection fractions of acromegaly patients were higher than the healthy reference values. Male patients had thicker LV myocardia, wider ventricular diameters and more dilated pulmonary artery roots than female patients. After surgery, LV myocardial hypertrophy was reversed, the left atrium was remodeled, and ventricular systolic dysfunction recovered to normal. Cardiac alterations were detected early in the 3rd postoperative month and persisted until the 12th month. The interventricular septum was initially thickened in the 3rd postoperative month and then recovered at the 12th month. Notable postoperative cardiac reversibility was observed in male patients but did not occur in all female patients. Patients achieving endocrine remission with normalized hormone levels had thinner LV myocardia than patients without normalized hormone levels.ConclusionOur findings demonstrated that some of the cardiac involvement in acromegaly patients is reversible after surgical treatment which lowers hormone levels. Endocrine remission and gender significantly impacted postoperative cardiac reversibility.

Highlights

Elevated levels of serum growth hormone (GH), combined with its product hormone insulin-like growth factor 1 (IGF-1), contribute to the systemic complications responsible for the increased mortality of acromegaly patients [1, 2]
On the basis of our previous study on baseline cardiac involvement in a series of untreated Chinese acromegaly patients using cardiovascular magnetic resonance (CMR) [25], the current study focused on the reversibility of cardiac involvement after transsphenoidal adenomectomy and the impacts of gender and endocrine remission (ER)
For dimensions of the heart and arteries, we evaluated the left ventricular (LV) longitudinal diameter (LVLD), LV transverse diameter (LVTD), RVLD, RVTD, left atrial LD (LALD), LATD, right atrial LD (RALD), and RATD

Summary

Introduction

Elevated levels of serum growth hormone (GH), combined with its product hormone insulin-like growth factor 1 (IGF-1), contribute to the systemic complications responsible for the increased mortality of acromegaly patients [1, 2]. Several studies have used CMR to evaluate cardiac involvement in acromegaly patients [20,21,22,23,24,25], and the results of these studies showed that the incidence rates of myocardial fibrosis, left ventricular (LV) systolic dysfunction (LVSD), and LV hypertrophy in acromegaly patients were 0% to 14.8%, 0% to 12.5%, and 5% to 72%, respectively. Some of these studies focused on the posttreatment reversibility of cardiac involvement, but the results are controversial. The reversibility of cardiac involvement after surgery has not been systematically evaluated

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