Growth hormone deficiency in succesfully treated acromegalic patients is not protective from cardiac complications

GH hypersection results in biventricular concentric hypertrophy and a progressive contractile impairment whereas cardiac hypotrophy and impaired diastolic filling and left ventricular function have been reported in GH deficiency (GHD). No information on cardiac performances and structure are available about those acromegalic patients in whom successful treatment made their GH and IGF-I secretion similar to those in GHD patients. In order to study the functional and structural cardiac consequences of optimal treatment for acromegaly, we enrolled 12 active acromegalic patients (group A), 14 post-surgical cured acromegalic patients with selective secondary GHD (group B), 11 cured acromegalic paties under treatment with SS analogs (group C), 21 GHD (group D) and 18 controls (group E). GHD diagnosis was based on GHRH+arginine test. In all the subjects LVMi, EF and E/A was studied by M-B mode echo-Doppler. IGF-I levels were higher in group A respect to groups B, C, D (P<0.0005, P<0.005, P<0.0005, respectively) whereas it was lower in group B than group C (P<0.005) but similar to group D. LVMi in group A was higher than in group E (P<0.0005) in which it was similar to group D. LVMi in group B were similar than in group A, whereas in group C it was lower than in groups A and in B (P<0.0005, P<0.05, respectively), still persisting higher than in group D and in group E (P<0.05, P<0.0005, respectively). EF in group A was similar to group E in whom it was higher than in group D (P<0.05). EF in group B was similar as in group A, while in group C it resulted higher than in group D and E (P< 0.0005, P<0.005) but still similar to group A. E/A in group A was lower than in group E (P<0.005) in which it was higher than in group D (P< 0.0005). In group B, E/A was lower than in group A (P<0.05) but similar to in group D. In group C, E/A were similar to in group A, but still lower than in group E (P<0.05) and similar to group D. In conclusion these data suggest that GH deficiency induced by successful treatment of acromegaly does not per se counteract cardiac abnormalities induced by acromegalic cardiomyopthy. Despite similar GH and IGF-I levels, treatment with SS analogues appears more effective in reducing cardiac mass and to improve diastolic function suggesting a potential GH-independent direct role of SS at the cardiac level.