Endocrine Abstracts

Somatostatin analogues (SA) are known to revert acromegalic cardiomyopathy mainly in young patients with short disease duration, whereas pegvisomant (PEG) reportedly improves cardiac structure and performance in patients resistant to SA. To date, no data are available on the effects of long-term SA+PEG on cardiovascular complications. The current study aimed at investigating the effects of long-term SA+PEG on cardiac structure and performance in acromegaly. Thirty-six acromegalic patients (14M, 22F, aged 52.3±10.2 years) entered the study. Weight, BMI, systolic (SBP) and diastolic (DBP) blood pressure, IGF1, fasting glucose (FG), fasting insulin (FI), HOMA-IR, HbA1c and lipids were evaluated at diagnosis (T0), after long-term (median 36 months, range 6–156 months) SA (T1), and after 12 (T12) and 60 (T60) months of SA+PEG, with last follow up (LFU) being performed after a median time of 78 months (range 60–144 months). At each time point all patients underwent echocardiography. SA induced a slight but not significant decrease in IGF1 (P=0.077), whereas FI (P=0.004), HOMA-IR (P=0.013), ejection fraction (EF, P=0.013), early (E) to late (A) ventricular filling velocities (E/A, P=0.001) and isovolumetric relaxation time (IVRT, P=0.000) significantly improved. At T12 weight (P=0.004), BMI (P=0.005), IGF1 (P=0.000), FI (P=0.001), HOMA-IR (P=0.000), left ventricular mass index (LVMi, P=0.000) and E/A (P=0.006) significantly improved compared to T0, with HOMA-IR further improving (P=0.000) compared to T1. At T60, IGF1 (P=0.000), FI (P=0.001), HOMA-IR (P=0.000), E/A (P=0.05) and IVRT (P=0.014) significantly ameliorated compared to T0. At LFU IGF1 normalized in 83.3%; IGF1 (P=0.000), FG (P=0.043), FI (P=0.000), HOMA-IR (P=0.000), HDL (P=0.031), EF (P=0.035), LVMi (P=0.000), E/A (P=0.02) and IVRT (P=0.001) significantly improved compared to T0. PEG dose significantly correlated with LVMi at T12 (r=0.575, P=0.000) and T60 (r=0.403, P=0.037). In conclusion, long-term PEG addition to SA improves cardiac structure and performance, particularly diastolic dysfunction, in acromegalic patients resistant to SA.