Cardiac dysfunction in acromegaly: evidence by pulsed wave tissue Doppler imaging

Objective: To verify whether the accuracy of data on myocardial function pr ovided by pulsed-wave tissue Doppler imaging (PWTDI), a new echocardiograph ic application that allows quantitative measurements of myocardial wall vel ocities, could help torn ards a better understanding of the natural history of acromegalic cardiomyopathy. Design: Eighteen patients with active acromegaly (ten men and eight women; mean age 48.0 +/- 15.0 years) with no other detectable cause of heart disea se underwent PWTDI. Thirteen healthy individuals matched for age and body m ass index acted as a control group. Methods: Ejection fraction (EF), transmitral early/late diastolic velocity (E/A) ratio and isovolumic relaxation time (IVRT) were measured by conventi onal echocardiography; systolic peak (Sv) and early (Ev) and late (Av) dias tolic peak velocities, Ev/Av ratio and regional IVRT (IVRTs) were obtained by PWTDI. Results: All patients showed appreciably abnormal left ventricular global d iastolic function represented by prolongation of the IVRT (P < 0.001). Usin g PWTDI we found a prolongation of IVRTs and inversion of the Ev/Av ratio. In addition, the Ev/Av ratio proved to be significantly negatively correlat ed with IVRT; this correlation was not present in the case of the E/A ratio . Furthermore, a decrease in Sv was detected in the basal segment of the la teral wall (P < 0.01), which had the greatest degree of diastolic dysfuncti on. Conclusions: PWTDI confirmed the acknowledged diastolic dysfunction that ac companies acromegalic cardiomyopathy and highlighted the greater sensitivit y of regional PWTDI with respect to global Doppler diastolic indexes. Furth ermore, by revealing an impairment of regional systolic function in presenc e of a normal EE the findings with PWTDI contradicted the largely accepted theory that systolic function remains normal for several years in patients affected by acromegalic cardiomyopathy.