Long-term outcome of patients with acromegaly and congestive heart failure
Long-term outcome of patients with acromegaly and congestive heart failure
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DOI：
10.1210/jc.2004-0821
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发表时间：
2004-11-01
影响因子：
5.8
通讯作者：
Chanson, P
中科院分区：
文献类型：
--
作者：
Bihan, H;Espinosa, C;Chanson, P
心血管并发症是肢端肥大症患者发病和死亡的主要原因。 GH 分泌正常化与结构和功能性心脏异常的改善相关。然而，尚未在已经患有慢性充血性心力衰竭 (CHF) 的患者中研究肢端肥大症治疗的长期心脏影响。我们回顾了自 1985 年以来在法国和比利时两个中心连续治疗的 330 名肢端肥大症患者的图表。对 10 名同时患有肢端肥大症和 CHF 的患者（8 名男性，2 名女性，平均年龄 49.7 岁）进行了回顾性研究。其中一名被排除，因为 CHF 是由严重主动脉瓣狭窄引起的。 CHF（纽约心脏协会 III-IV 期，超声心动图显示扩张型低运动性心肌病，伴左心室收缩功能障碍，左心室射血分数低于 45%）分别在肢端肥大症之前、同时或之后诊断出 2 名、5 名和 2 名患者。三名患者因终末心力衰竭需要移植而转诊。一名患者患有与高血压危象相关的短暂性心力衰竭。其他八名患者患有有症状的慢性CHF。三名患者的 GH 分泌过多的控制完全或部分失败：一名患者长期存活，另外两名患者在 1 岁和 5 岁时死亡。 5 名患者的 GH 控制良好：其中 4 名在诊断 CHF 后 2-16 年仍存活，临床状态稳定或改善，生活质量良好。总体而言，慢性症状性 CHF 患者的 1 年和 5 年死亡率（或移植）率分别为 25%（8 名患者中的 2 名）和 37.5%（8 名患者中的 3 名）。 总之，在本研究中，肢端肥大症患者中不到 3% 发生 CHF。尽管肢端肥大症的有效治疗可以改善短期心血管状况，但其对长期生存的影响值得怀疑。
Cardiovascular complications are a major cause of morbidity and mortality in patients with acromegaly. Normalization of GH secretion is associated with an improvement in structural and functional cardiac abnormalities. However, the long-term cardiac effects of treatment for acromegaly have not been studied in patients who have already developed chronic congestive heart failure (CHF).We reviewed the charts of 330 consecutive patients with acromegaly treated in two French and Belgian centers since 1985. Ten patients with both acromegaly and CHF (eight men, two women, mean age 49.7 yr) were studied retrospectively. One of them was excluded because CHF was due to severe aortic stenosis.CHF ( New York Heart Association stages III-IV and echocardiography showing dilated hypokinetic cardiomyopathy with left ventricular systolic dysfunction and a left ventricular ejection fraction less than 45%) was diagnosed before, concomitantly, or after acromegaly in, respectively, two, five, and two patients. Three patients were referred with terminal heart failure requiring transplantation.One patient had transient CHF associated with a hypertensive crisis. The other eight patients had symptomatic chronic CHF. Control of GH hypersecretion failed, totally or partially, in three patients: one had a long-term survival, and the two others died at 1 and 5 yr. Good GH control was achieved in five patients: four of these are still alive 2-16 yr after diagnosis of CHF, their clinical status is stable or improved, and their quality of life is good. Overall, the 1- and 5-yr mortality ( or transplantation) rates for patients with chronic symptomatic CHF were 25% ( 2 of 8 patients) and 37.5% ( 3 of 8 patients), respectively.In conclusion, less than 3% of acromegalic patients developed CHF in this study. Although effective treatment of acromegaly improved short-term cardiovascular status, its impact on long-term survival is questionable.