Akromegali Hastalarında Aritmik Olayların ve Öngördürücülerinin Belirlenmesi

Abstract

Cardiovascular complications are the most common causes of morbidity and mortality in acromegaly. Arhythmias and conduction abnormalities are important manifestations of cardiac involvement in patients with acromegaly. However, there is little data regarding cardiac autonomic functions in these patients. In these study, we aimed to investigate several parameters of cardiac autonomic functions and evaluate echocardiographic systolic and diastolic functions in patients with acromegaly compared to healthy subjects. Twenty-one newly diagnosed acromegalic patients (57,1% female, age: 45,76±12,4 years) and 27 age and gender-matched healthy subjects were enrolled in these study. All participants underwent 24h Holter recording and transthorasic echocardiographic (TTE) examination. Heart rate recovery (HRR) indices were calculated by subtracting 1st, 2nd and 3rd minute heart rates from maximal heart rate. All patients underwent heart rate variability (HRV) and QT dynamicity analysis. Baseline characteristics were similar except diabetes mellitus and hypertension among groups. All patients underwent transsphenoidal surgery (TSS), also five (23,8%) patients treated with octreotid and one (4,8%) patient had radiotherapy. Mean HRR1 (27,81±12,4 vs 42,48±6,6, p=0.001), HRR2 (43,43±15,3 vs 61,48±11,5, p=0,001) and HRR3 (47,71±15,4 vs 65,63±10,5, p=0,001) values were significantly higher in control group. HRV parameters as, SDNN (p=0,001), SDANN (p=0,001), RMSSD (p=0,001), PNN50 (p=0,001), variability index (p=0,001) and HF (p=0,001) were significantly decreased in patients with acromegaly; but mean heart rate (p=0,001), LF (p=0,012) and LF/HF (p=0,001) were significantly higher in acromegaly patients. QTec (p=0,005), QTac/RR slope (p=0,001) and QTec/RR slope (p=0,001) were significantly higher in patients with acromegaly.End diastolic diameter (4,9±0,4 vs 4,7±0,3, p=0,019), posterior wall thickness (1,03±0,1 vs 0,93±0,1, p=0,001), septal thickness (1,08±0,1 vs 0,93±0,1, p=0,001), left atrial diameter (3,51±0,3 vs 3,32±0,4, p=0,049), right ventricle diameter (2,76±0,2 vs 2,54±0,1, p=0,001) and septal E/E' ratio (8,25±3,1 vs 6,37±1,7, p=0,01) values were significantly higher in acromegalic patients; but tricuspid annular plane systolic excursion (TAPSE) (22,08±2,9 vs 24,15±1,4, p=0,032), E/A ratio (0,92±0,2'e karşı 1,2±0,3, p=0,002) and septal E' (9,13±2,9'e karşı 12,90±1,7, p=0,001) values were significantly decreased in patients with acromegaly. Additionally, there were significant negative correlation of disease duration with HHR1, HRR2, HRR3, SDNN, E/A ratio and significant positive correlation of disease duration with septal thickness. At a median follow-up time of 10 months; HRR1, HRR2, HRR3, PNN50, RMSSD, E/A ratio, septal E' and TAPSE were significantly increased, LF/HF, mean heart rate, septal thickness, posterior wall thickness, left atrial diameter and IVRT were significantly decreased in patients with acromegaly after the treatment (P<0,05). Our study results suggest that cardiac autonomic functions and left ventricular diastolic functions are impaired in patients with acromaegaly. Also we showed thatthe treatment of acromegaly makes significant improvement in many parameters of cardiac autonomic functions and left ventricular diastolic functions.