Acromegaly and Heart Failure

Annamaria Colao, Ludovica F.S. Grasso, Carolina Di Somma, Rosario Pivonello

Research output: Contribution to journalReview articlepeer-review

Abstract

In patients with acromegaly, chronic GH and IGF-I excess commonly causes a specific cardiomyopathy characterized by a concentric cardiac hypertrophy associated with diastolic dysfunction and, in later stages, with systolic dysfunction ending in heart failure in untreated and uncontrolled patients. Additional relevant cardiovascular complications are represented by arterial hypertension, valvulopathies, arrhythmias, and vascular endothelial dysfunction, which, together with the respiratory and metabolic complications, contribute to the development of cardiac disease and the increase cardiovascular risk in acromegaly. Disease duration plays a pivotal role in the determination of acromegalic cardiomyopathy. The main functional disturbance in acromegalic cardiomyopathy is the diastolic dysfunction, observed in 11% to 58% of patients, it is usually mild, without clinical consequence, and the progression to systolic dysfunction is generally uncommon, not seen or observed in less than 3% of the patients. Consequently, the presence of overt CHF is rare in acromegaly, ranging between 1 and 4%, in patients with untreated and uncontrolled disease. Control of acromegaly, induced by either pituitary surgery or medical therapy improves cardiac structure and performance, limiting the progression of acromegaly cardiomyopathy to CHF. However, when CHF is associated with dilative cardiomyopathy, it is generally not reversible, despite the treatment of the acromegaly.

Original languageEnglish
Pages (from-to)399-408
Number of pages10
JournalHeart Failure Clinics
Volume15
Issue number3
DOIs
Publication statusPublished - Jul 2019

Keywords

  • Acromegaly
  • Cardiomyopathy
  • Heart failure
  • Medical therapy
  • Pituitary adenoma

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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