Cardiac effects of 3months treatment of acromegaly evaluated by magnetic resonance imaging and B-type natriuretic peptides

Long-term treatment of acromegaly prevents aggravation and reverses associated heart disease. A previous study has shown a temporary increase in serum levels of the N-terminal fraction of pro B-type natriuretic peptide (NT-proBNP) suggesting an initial decline in cardiac function when treatment of acromegaly is initiated. This was a three months prospective study investigating short-term cardiac effects of treatment in acromegalic patients. Cardiac function was evaluated by the gold standard method cardiac magnetic resonance imaging (CMRI) and circulating levels of B-type natriuretic peptides (BNP and NT-proBNP). CMRI was performed at baseline and after 3months of treatment. Levels of IGF-I, BNP and NT-proBNP were measured after 0, 1, 2 and 3months. Eight patients (5 males and 3 females, mean age 53 plus or minus 12years (range 30-70)) and 8 matched healthy control subjects were included. Median IGF-I Z-score decreased from 4.5 (range 2.5-6.4) to 2.3 (-0.1 to 3.3). At baseline the patients had increased left ventricle mass index (LVMI) compared to control subjects ( Delta LVMI 35g/m super(2) (95% CI 8-63g/m super(2), P=0.016). After 3months of treatment there was an increase in end-diastolic volume index EDVI ( Delta EDVI 9mL/m super(2) (95% CI 3-14), P=0.007) and an increase in levels of BNP (median (ranges) 7 (0.58-286) vs. 20 (1-489)pg/mL, P=0.033) and of NT-proBNP (63 (20-1004) vs. 80 (20-3391) pg/mL, P=0.027). Assessed by the highly sensitive and precise CMRI method, 3months treatment of acromegaly resulted in an increase in EDVI, and increased levels of BNP and NT-proBNP suggesting an initial decrease in cardiac function.