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Abstract：
Despite the preserved LVEF, patients with acromegaly are characterized by subclinical systolic dysfunction i.e., abnormal global longitudinal strain (GLS) assessed by speckle tracking echocardiography (STE). The effect of acromegaly treatment on LV systolic function assessed by STE, has not been evaluated so far.
Thirty-two naïve acromegalic patients without detectable heart disease were enrolled in a prospective, single-center study. 2D-Echocardiography and STE were performed at diagnosis, 3&6 months on preoperative somatostatin receptor ligand (SRL) treatment and 3 months after transsphenoidal surgery (TSS).
Treatment with SRL resulted in reduction in median (IQR) GH&IGF-1 levels after 3 months, from 9.1(3.2-21.9) to 1.8(0.9-5.2) ng/mL (p<0.001) and from 3.2(2.3-4.3) to 1.5(1.1-2.5) xULN (p<0.001), respectively. Biochemical control on SRL was achieved in 25.8% of patients after 6 months and complete surgical remission was achieved in 41.7% of patients. TSS resulted in decrease in median (IQR) IGF-1 compared to IGF-1 levels on SRL treatment: from 1.5(1.2-2.5) to 1.3(1.0-1.6) xULN (p=0.003). Females had lower IGF-1 levels at baseline, on SRL and after TSS compared to males. The median end diastolic and end systolic left ventricle volumes were normal. Almost half of the patients (46.9%) had increased LVMi, however the median value of LVMi was normal in both sex groups: 99g/m2 in males and 94g/m2 in females. Most patients (78.1%) had increased LAVi and the median value was 41.8mL/m2. At baseline 50% of patients, mostly men (62.5% vs. 37.5%) had GLS values higher than -20%. There was a positive correlation between baseline GLS and BMI r=0.446 (p=0.011) and BSA r=0.411 (p=0.019). The median GLS significantly improved after 3 months of SRL treatment compared to baseline: -20.4% vs. -20.0% (p=0.045). The median GLS was lower in patients with surgical remission compared to patients with elevated GH&IGF-1 levels: -22.5% vs. -19.8% (p=0.029). There was a positive correlation between GLS and IGF-1 levels after TSS r=0.570 (p=0.007).
The greatest beneficial effect of acromegaly treatment on LV systolic function is visible already after 3 months of preoperative SRL treatment, especially in women. Patients with surgical remission have better GLS compared to patients with persistent acromegaly.
Thirty-two naïve acromegalic patients without detectable heart disease were enrolled in a prospective, single-center study. 2D-Echocardiography and STE were performed at diagnosis, 3&6 months on preoperative somatostatin receptor ligand (SRL) treatment and 3 months after transsphenoidal surgery (TSS).
Treatment with SRL resulted in reduction in median (IQR) GH&IGF-1 levels after 3 months, from 9.1(3.2-21.9) to 1.8(0.9-5.2) ng/mL (p<0.001) and from 3.2(2.3-4.3) to 1.5(1.1-2.5) xULN (p<0.001), respectively. Biochemical control on SRL was achieved in 25.8% of patients after 6 months and complete surgical remission was achieved in 41.7% of patients. TSS resulted in decrease in median (IQR) IGF-1 compared to IGF-1 levels on SRL treatment: from 1.5(1.2-2.5) to 1.3(1.0-1.6) xULN (p=0.003). Females had lower IGF-1 levels at baseline, on SRL and after TSS compared to males. The median end diastolic and end systolic left ventricle volumes were normal. Almost half of the patients (46.9%) had increased LVMi, however the median value of LVMi was normal in both sex groups: 99g/m2 in males and 94g/m2 in females. Most patients (78.1%) had increased LAVi and the median value was 41.8mL/m2. At baseline 50% of patients, mostly men (62.5% vs. 37.5%) had GLS values higher than -20%. There was a positive correlation between baseline GLS and BMI r=0.446 (p=0.011) and BSA r=0.411 (p=0.019). The median GLS significantly improved after 3 months of SRL treatment compared to baseline: -20.4% vs. -20.0% (p=0.045). The median GLS was lower in patients with surgical remission compared to patients with elevated GH&IGF-1 levels: -22.5% vs. -19.8% (p=0.029). There was a positive correlation between GLS and IGF-1 levels after TSS r=0.570 (p=0.007).
The greatest beneficial effect of acromegaly treatment on LV systolic function is visible already after 3 months of preoperative SRL treatment, especially in women. Patients with surgical remission have better GLS compared to patients with persistent acromegaly.
摘要：
■尽管保留了LVEF，肢端肥大症患者的特征是亚临床收缩功能障碍，即通过斑点追踪超声心动图（STE）评估异常的整体纵向应变（GLS）。通过STE评估肢端肥大症治疗对LV收缩功能的影响，到目前为止还没有评估。
■32名没有可检测到心脏病的初治肢端肥大症患者被纳入一项前瞻性研究，单中心研究。诊断时进行二维超声心动图和STE，术前3&6个月采用生长抑素受体配体（SRL）治疗，术后3个月采用经蝶窦手术（TSS）。
■3个月后，SRL治疗导致GH和IGF-1水平中位数（IQR）降低，从9.1（3.2-21.9）到1.8（0.9-5.2）ng/mL（p<0.001），从3.2（2.3-4.3）到1.5（1.1-2.5）xULN（p<0.001），分别。6个月后，25.8％的患者实现了SRL的生化控制，41.7％的患者实现了完全缓解。与SRL治疗的IGF-1水平相比,TSS导致中值(IQR)IGF-1水平降低:从1.5(1.2-2.5)至1.3(1.0-1.6)xULN(p=0.003)。女性在基线时IGF-1水平较低，与男性相比，在SRL和TSS之后。中位舒张末期和收缩末期左心室容积正常。几乎一半的患者（46.9％）LVMi升高，然而，两个性别组的LVMi中位数均正常：男性为99g/m2，女性为94g/m2。大多数患者（78.1％）的LAVi升高，中位值为41.8mL/m2。在基线时，50%的患者，主要是男性(62.5%vs.37.5%)的GLS值高于-20%。基线GLS与BMIr=0.446(p=0.011)和BSAr=0.411(p=0.019)呈正相关。与基线相比，SRL治疗3个月后GLS中位数显着改善：-20.4%-20.0%（p=0.045）。与GH和IGF-1水平升高的患者相比，手术缓解的患者的GLS中位数较低：-22.5％-19.8%（p=0.029）。TSS后GLS和IGF-1水平呈正相关(p=0.007)。
■在术前SRL治疗3个月后，肢端肥大症治疗对左心室收缩功能的最大有益作用已经显现，尤其是女性。与持续性肢端肥大症患者相比，手术缓解患者的GLS更好。
■32名没有可检测到心脏病的初治肢端肥大症患者被纳入一项前瞻性研究，单中心研究。诊断时进行二维超声心动图和STE，术前3&6个月采用生长抑素受体配体（SRL）治疗，术后3个月采用经蝶窦手术（TSS）。
■3个月后，SRL治疗导致GH和IGF-1水平中位数（IQR）降低，从9.1（3.2-21.9）到1.8（0.9-5.2）ng/mL（p<0.001），从3.2（2.3-4.3）到1.5（1.1-2.5）xULN（p<0.001），分别。6个月后，25.8％的患者实现了SRL的生化控制，41.7％的患者实现了完全缓解。与SRL治疗的IGF-1水平相比,TSS导致中值(IQR)IGF-1水平降低:从1.5(1.2-2.5)至1.3(1.0-1.6)xULN(p=0.003)。女性在基线时IGF-1水平较低，与男性相比，在SRL和TSS之后。中位舒张末期和收缩末期左心室容积正常。几乎一半的患者（46.9％）LVMi升高，然而，两个性别组的LVMi中位数均正常：男性为99g/m2，女性为94g/m2。大多数患者（78.1％）的LAVi升高，中位值为41.8mL/m2。在基线时，50%的患者，主要是男性(62.5%vs.37.5%)的GLS值高于-20%。基线GLS与BMIr=0.446(p=0.011)和BSAr=0.411(p=0.019)呈正相关。与基线相比，SRL治疗3个月后GLS中位数显着改善：-20.4%-20.0%（p=0.045）。与GH和IGF-1水平升高的患者相比，手术缓解的患者的GLS中位数较低：-22.5％-19.8%（p=0.029）。TSS后GLS和IGF-1水平呈正相关(p=0.007)。
■在术前SRL治疗3个月后，肢端肥大症治疗对左心室收缩功能的最大有益作用已经显现，尤其是女性。与持续性肢端肥大症患者相比，手术缓解患者的GLS更好。
