Growth hormone status predicts left ventricular mass in patients after cure of acromegaly.
Growth hormone status predicts left ventricular mass in patients after cure of acromegaly.
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DOI：
10.1016/j.ghir.2010.05.003
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发表时间：
2010-10
影响因子：
1.4
通讯作者：
Klibanski, Anne
中科院分区：
文献类型：
--
作者：
Wexler, Tamara L.;Durst, Ronen;McCarty, David;Picard, Michael H.;Gunnell, Lindsay;Omer, Zehra;Fazeli, Pouneh;Miller, Karen K.;Klibanski, Anne
生长激素过量和生长激素缺乏症（GHD）都与心血管疾病发病率增加有关。一种特殊的肢端肥大症相关的心肌病已被描述，其特征部分是增加左心室质量（LVM）。生长激素缺乏与左心室质量降低有关。肢端肥大症经手术或放射治疗治愈后，可能发生GHD;然而，其对该人群心脏形态和功能的影响尚未确定。我们假设，既往有肢端肥大症的患者发生GHD与心脏形态学和功能改变有关，这些改变不同于肢端肥大症治愈后GH充足的患者。在临床研究中心进行了一项横断面研究。研究参与者包括三组受试者（n=34）：I.治愈肢端肥大症伴GHD（n=15），II.治愈的肢端肥大症与GH充足（n=8），和III。活动性肢端肥大症（n=11）。主要结果指标包括心脏形态和功能，使用超声心动图参数。三组的平均年龄和BMI分别为44.6±2.3岁（SEM）和30.7±1.3 kg/m2，无差异。平均GH峰值为：I. 2.8± 0.4ng/ml; II. 30.1±9.1 ng/ml（p=0.0002.）在组I中，所有患者的左心室质量（以体表面积（LVMi）为指数）均在正常范围内;此外，左心室（LV）几何结构正常。组II和组III中至少50%的患者LVMi升高，50%的患者LV几何结构异常，表明病理性肥大。射血分数在所有三组之间相似。舒张功能无显著差异。与有肢端肥大症病史但GH水平正常的患者或活动性肢端肥大症患者相比，肢端肥大症治愈后发生GHD的患者未表现出LV质量升高。提示肢端肥大症治疗后的GH状态与左室质量相关，并且在GH充足的患者中，重构逆转可能比以前认为的慢。这些数据表明，这将是重要的，以确定是否GH替代改变左心室形态随着时间的推移。
Growth hormone excess and growth hormone deficiency (GHD) are both associated with increased cardiovascular morbidity. A specific acromegaly-related cardiomyopathy has been described, characterized in part by increased left ventricular mass (LVM). Growth hormone deficiency is associated with reduced LVM. Following cure of acromegaly with surgery or radiation therapy, GHD may develop; however, its effects on cardiac morphology and function in this population are not established. We hypothesized that the development of GHD in patients with prior acromegaly would be associated with cardiacmorphologic and functional changes that differ from those in patients who are GH sufficient following cure of acromegaly. A cross-sectional study was conducted in a Clinical Research Center. Study participants consisted of three groups of subjects (n=34): I. Cured acromegaly with GHD (n=15), II. Cured acromegaly with GH sufficiency (n=8), and III. Active acromegaly (n=11). Main outcome measures included cardiac morphology and function, using echocardiography parameters. Mean age and BMI, 44.6±2.3 years (SEM) and 30.7±1.3 kg/m2, respectively, were not different among the three groups. Mean peak GH values were: I. 2.8±0.4 ng/ml; II. 30.1±9.1 ng/ml (p=0.0002.) In group I, left ventricular mass, indexed to body surface area (LVMi), was within the normal range in all patients; moreover, left ventricular (LV) geometry was normal. At least 50% of patients in groups II and III had elevated LVMi, and in 50% of patients, LV geometry was abnormal, indicating pathologic hypertrophy. Ejection fraction was similar between all three groups. There were no significant differences in diastolic function. Patients who develop GHD following cure of acromegaly do not demonstrate elevated LV mass, in contrast to patients with a history of acromegaly but normal GH levels or to patients with active acromegaly. This suggests that GH status after treatment of acromegaly correlates with LV mass, and that, in GH sufficient patients, reversal of remodeling may be slower than previously thought. These data suggest that it will be important to determine whether GH replacement alters left ventricular morphology over time.
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