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Cardiac manifestations of growth hormone deficiency after treatment for acromegaly: a comparison to patients with biochemical remission and controls

A van der Klaauw, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, 2333 ZA, Netherlands
J Bax, Cardiology, Leiden University Medical Center, Leiden, Netherlands
G Bleeker, Cardiology, Leiden University Medical Center, Leiden, Netherlands
E Holman, Cardiology, Leiden University Medical Center, Leiden, Netherlands
V Delgado, Cardiology, Leiden University Medical Center, Leiden, Netherlands
J Smit, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
J Romijn, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
A Pereira, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands

Correspondence: Aa van der Klaauw, Email: a.a.van_der_klaauw{at}lumc.nl

Abstract

Objective: Both growth hormone (GH) excess and GH deficiency (GHD) lead to specific cardiac pathology. The aim of this study was to evaluate cardiac morphology and function in patients with GHD after treatment for acromegaly.

Design: Cross-sectional study.

Patients and methods: Cardiac parameters were studied by conventional two-dimensional echocardiography and Tissue Doppler imaging in 53 patients with acromegaly (16 patients with GHD, 20 patients with biochemical remission, and 17 patients with active disease). Patients with GHD were also compared to age- and gender-matched controls.

Results: Left ventricular (LV) dimensions, wall thickness, and mass did not differ between the three groups, or between the patients with GHD and healthy controls. Systolic function, assessed by LV ejection fraction, tended to be lower in patients with GHD compared to patients with biochemical remission (65.9 ± 7.3 % vs. 72.4 ± 8.5 %, P=0.070), but was higher when compared to active acromegaly (58.8 ± 9.3 %, P=0.047). No differences were found with healthy controls. Diastolic function, measured with early diastolic velocity (E’), was lower in patients with GHD both when compared to patients with biochemical remission (6.0 ± 2.1 cm/s vs. 8.3 ± 1.5 cm/s, P=0.005) and to healthy controls (8.1 ± 1.9 cm/s, P=0.006).

Conclusion: GHD after acromegaly results in specific decrease in diastolic function compared to patients with biochemical remission of acromegaly and healthy controls. In addition, systolic function tends to be decreased in patients with GHD compared to patients with biochemical remission, but was higher than in patients with active acromegaly.