Myocardial systolic strain abnormalities in patients with acromegaly: a prospective color Doppler imaging study

Background: Heart abnormalities are frequent findings in patients with acromegaly: systolic abnormalities are considered to be secondary to diastolic changes. Aim: The aim of the study was to evaluate whether early systolic abnormalities might be revealed in acromegalic patients using the high sensitive color Doppler myocardial imaging (CDMI) technique. Patients and methods: Twenty-two consecutive acromegalic patients with active untreated disease (ACRO(UNTR)) were evaluated at baseline and after a 6-month course with SS analogs (SSa) (ACRO(SSa)); 25 healthy subjects served as controls. All subjects underwent conventional 2D-color Doppler echocardiography, pulse wave tissue Doppler imaging (PW-TDI) and CDMI. Results: Mean left ventricular (LV) ejection fraction did not differ in ACRO(UNTR) and in controls; at variance, ACRO(UNTR) patients had reduced mean LV diastolic function (E/A ratio: 0.96 +/- 0.3 vs controls: 1.6 +/- 0.3; p < 0.002). Impairment of global LV diastolic function was confirmed by PW-TDI in ACRO(UNTR) patients having a normal systolic function. Regional myocardial systolic strain (F) and strain rate (SR) values, indices of regional systolic heart deformation, were lower in ACRO(UNTR) [epsilon(sys) (s) -19.8 +/- 2.9 and E S (Q: -17.7 +/- 2.2] than in controls [epsilon(sys) (s):-27.9 +/- 3.9s p < 0.001 and E (L). -25.3 +/- 2.6; p < 0.001]. In addition, the early phase, of diastolic function, evaluated using SR parameters, was impaired in acromegalic patients (p < 0.005 vs controls). Strain and SIR values were related to serum GH and IGF-I levels (p < 0.02) and greatly improved after a 6-month course with SSa [epsilon(sys) (s) improved to -23.8 +/- 3.8 (p < 0.05) and epsilon(sys) (L) improved to -24.7 +/- 2.4 (p < 0.03)]. Conclusions: Our study confirms that ACRO(UNTR) patients have impaired diastolic function. More important, our study clearly shows that ACRO(UNTR) patients have an impairment of regional myocardial systolic function, which is not secondary to diastolic changes. These intramyocardial functional abnormalities improved during medical treatment of acromegaly. It is conceivable that GH-IGF-I excess has detrimental effects either on the diastolic or the systolic phases of heart function.