Effects of long-term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance
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ORIGINAL ARTICLE
Effects of long-term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance in acromegaly Renata S. Auriemma1 • Ludovica F. S. Grasso1 • Mariano Galdiero1 • Maurizio Galderisi2 • Claudia Pivonello1 • Chiara Simeoli1 • Maria Cristina De Martino1 • Rosario Ferrigno1 • Mariarosaria Negri1 • Cristina de Angelis1 • Rosario Pivonello1 • Annamaria Colao1 Received: 12 January 2016 / Accepted: 19 May 2016 Ó Springer Science+Business Media New York 2016
Abstract To date, no data are available on the effects of long-term combined treatment with somatostatin analogues (SA) and pegvisomant (PEG) on cardiovascular complications in acromegaly. The current study aimed at investigating the effects of long-term SA ? PEG on cardiac structure and performance. Thirty-six patients (14 M, 22 F, aged 52.3 ± 10.2 years) entered this study. Weight, BMI, systolic (SBP) and diastolic (DBP) blood pressure, IGF-I, fasting glucose (FG), fasting insulin (FI), HOMA-IR, HbA1c, and lipids were evaluated at baseline (T0), after long-term (median 36 months) SA (T1), after 12 (T12) and 60 (T60) months of SA ? PEG, and at last follow-up (LFU, median 78 months). At each time point, all patients underwent echocardiography. At T1, induced a slight but not significant decrease in IGF-I (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, IGF-I (p = 0.000) significantly reduced compared to T0, and FI (p = 0.001), HOMA-IR (p = 0.000), LVMI (p = 0.000), and E/A (p = 0.006) further improved compared to T1. At T60, FI (p = 0.027), HOMA-IR (p = 0.049), and E/A (p = 0.005) significantly improved as compared to T1. At LFU IGF-I normalized in 83.3 %, FI (p = 0.000), HOMAIR (p = 0.000), LVMi (p = 0.000), and E/A (p = 0.005)
& Rosario Pivonello [email protected] 1
Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Universita` Federico II, via S. Pansini 5, 80131 Naples, Italy
2
Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy
further improved as compared to T1. PEG dose significantly correlated with LVMi at T12 (r = 0.575, p = 0.000) and T60 (r = 0.403, p = 0.037). Long-term PEG addition to SA improves cardiac structure and performance, particularly diastolic dysfunction, in acromegalic patients resistant to SA. Keywords Acromegaly Pituitary tumors IGF-I Somatostatin analogues Pegvisomant Acromegalic cardiomyopathy Metabolic syndrome Insulin resistance Cardiac structure Cardiac performance Left ventricular hypertrophy Ejection fraction Diastolic dysfunction
Introduction The therapeutic goals for acromegaly comprise, besides the control of GH and IGF-I hypersecretion, the treatment of systemic comorbidities, including cardiovascular complications [1]. GH and IGF-I excess is responsible for the typical acromegalic car
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