Systemic hypertension and impaired glucose tolerance are independently correlated to the severity of the acromegalic cardiomyopathy

Increased mortality from cardiovascular diseases has been reported in acrom egaly. Our objective was to evaluate the impact of glucose tolerance abnorm alities and/or systemic hypertension in further worsening the acromegalic c ardiomyopathy. The study design was open transversal. The subjects studied were 130 consecutive naive acromegalic patients (74 women and 56 men; age, 17-80 yr). Interventricular septum (IST) and left ventricular (LV) posterio r wall thickness (PWT), LV mass index (LVMi), maximal early to late diastol ic flow velocity ratio (E/A), isovolumic relaxation time (IRT), and LV ejec tion fraction (EF) were measured by echocardiography. The results were anal yzed in line with the presence of glucose tolerance abnormalities (normal i n 60, impaired in 38, diabetes mellitus in 32) and the presence (in 46) or absence (in 84) of hypertension. Patients with impaired glucose tolerance a nd diabetes mellitus had significantly higher age (P = 0.01), and systolic (P = 0.01) and diastolic (P = 0.01)blood pressures and lower EIA(P = 0.01) and EF (P = 0.01) than those with normal glucose tolerance. Disease duratio n, circulating GH and insulin-like growth factor I (IGF-I) levels, IST, LVP WT, LVMi, and IRT were similar in the 3 groups. Normotensive patients had s ignificantly lower age (P < 0.001), LVPWT (P < 0.001), IST (P = 0.003), LVM i (P < 0.001), and IRT (P = 0.02) and significantly higher EIA (P < 0.001) and EF (P < 0.001) than hypertensive subjects. Disease duration, circulatin g GH, and IGF-I levels were similar in the 2 groups. Multiple regression analysis showed that systolic blood pressure was the st rongest predictor of LVMi (P = 0.0004), followed by GH levels (P = 0.02), w hereas diastolic blood pressure was the strongest predictor of LVEF reducti on (P < 0.0001), followed by glucose tolerance status (P = 0.02). Age was t he strongest predictor of both E/A impairment (P < 0.0001) and IRT (P = 0.0 1), followed by IGF-I levels (P = 0.02). Compared to patients with uncomplicated acromegaly, those with hypertension but without abnormalities of glucose tolerance had an increased prevalence of LV hypertrophy (75% vs. 37.2%) as well as of impaired diastolic (50% vs . 7.8%) and systolic function (18.7% vs. 3.9%), whereas patients with gluco se tolerance abnormalities but without hypertension had only an increased p revalence of impaired diastolic (39.7%) and systolic function (31.7%). The subgroup of acromegalic patients suffering from hypertension and diabetes m ellitus had the highest prevalence of LV hypertrophy (84.6%), diastolic fil ling abnormalities (69.2%), and impaired systolic function at rest (53.9%). A careful cardiac investigation should thus be performed in all acromegali c patients showing these complications.