Left Ventricular Diastolic Function and Cardiac Performance during Exercise in Patients with Acromegaly

• Published in: The journal of clinical endocrinology and metabolism Vol. 88; no. 9; pp. 4105 - 4109
• Main Authors: Spinelli, Letizia, Petretta, Mario, Verderame, Giuseppe, Carbone, Giuseppe, Venetucci, Angela Assunta, Petretta, Andrea, Acampa, Wanda, Bonaduce, Domenico, Colao, Annamaria, Cuocolo, Alberto
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.09.2003; Copyright by The Endocrine Society
• Subjects: Acromegaly - diagnostic imaging; Acromegaly - physiopathology; Adult; Biological and medical sciences; Blood Flow Velocity - physiology; Echocardiography; Echocardiography, Doppler; Endocrinopathies; Exercise - physiology; Female; Heart - diagnostic imaging; Heart - physiopathology; Heart Function Tests; Hormones - blood; Human Growth Hormone - blood; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - physiopathology; Hypothalamus. Hypophysis. Epiphysis (diseases); Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Radionuclide Angiography; Regression Analysis; Ventricular Function, Left - physiology; Endocrinopathy; Physical exercise; Human; Cardiac performance; Diastole; Pituitary diseases; Diseases of the osteoarticular system; Acromegaly; Myocardium; Functional analysis; Performance; Left ventricle
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2003-030462

Exercise-induced impairment of left ventricular (LV) ejection fraction is common in patients with acromegaly and normal resting systolic function. This study aimed to clarify whether diastolic dysfunction plays a role in the abnormal adaptation to exercise in these patients. Forty-eight patients with active acromegaly underwent LV radionuclide angiography at rest and during exercise. Doppler echocardiography was also performed to assess LV mass index and diastolic function by combined analysis of mitral and pulmonary flow velocity curves. LV ejection fraction at peak exercise was related to rest ejection fraction (r = 0.78; P < 0.001), peak filling rate (r = 0.55; P < 0.01), LV mass index (r = −0.56; P < 0.001), and the difference between duration of diastolic reverse pulmonary vein flow and mitral flow at atrial contraction (Δ duration) (r = −0.54; P < 0.01). At stepwise regression analysis, rest ejection fraction and Δ duration were the only variables that independently influenced (P < 0.001) ejection fraction at peak exercise. Diastolic dysfunction is important in determining cardiac performance during exercise in patients with acromegaly and normal resting systolic function. Combined analysis of pulmonary vein and mitral flow velocity curves allows the identification of impaired LV diastolic function in such patients.