Heart in acromegaly – proposal to modify the definition of acromegalic cardiomyopathy


acromegalic cardiomyopathy
speckle tracking echocardiography ( STE)
global longitudinal strain (GLS)

How to Cite

Popielarz-Grygalewicz, A., & Zgliczyński, W. (2023). Heart in acromegaly – proposal to modify the definition of acromegalic cardiomyopathy. Wiedza Medyczna, 5(1), 19-25. https://doi.org/10.36553/wm.161


Abstract: Acromegaly is a systemic disease significantly affecting cardiovascular system. As a result of increased GH and IGF-1 values, changes occur in the heart, which are commonly called acromegaly cardiomyopathy.

The progress in the treatment of acromegaly and comorbidities has changed the characteristics of this cardiomyopathy, and its 3rd stage is very rare today, it is reported from 1 to 4%. In turn, progress in diagnostics and the possibility of using new echocardiographic techniques, like speckle tracking echocardiography (STE), allows to  recognize the changes at the subclinical level.

Due to the reversibility of some symptoms, early detection of changes and implementation of treatment is very important. This reduces the risk of cardiac complications, and consequently improves the quality and prolongs life.



1. Zgliczyński W, Witek P, Zdunowski P: Guzy przysadki. [W:] Endokrynologia. Cz. I. Wielka Interna. Wyd I. Medical Tribune Polska 2011; 65-91.
2. Czajka-Oraniec I, Zgliczyński W. Acromegaly and cardiovascular diseases. Postępy Nauk Medycznych 11/2012, s. 866-871
3. Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A consensus on the diagnosis and treatment of acromegaly comorbidities: an update. J Clin Endocrinol Metab (2020) 105(4):dgz096. doi: 10.1210/clinem/dgz096
4. Bihan H, Espinosa C, Valdes-Socin H, Salenave S, Young J, Levasseur S, et al. Long-term outcome of patients with acromegaly and congestive heart failure. J Clin Endocrinol Metab (2004) 89(11):5308–13. doi: 10.1210/jc.2004-0821
5. Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr Rev (2019) 40(1):268–332. doi: 10.1210/er.2018-00115
6. Mosca S, Paolillo S, Colao A, Bossone E, Cittadini A, Iudice FL, et al. Cardiovascular involvement in patients affected by acromegaly: an appraisal. Int J Cardiol (2013) 167(5):1712–8. doi: 10.1016/j.ijcard.2012.11.109
7. Popielarz-Grygalewicz A, Gąsior JS, Konwicka A, Grygalewicz P, Stelmachowska-Banaś M, Zgliczyński W, et al. Heart in acromegaly: the echocardiographic characteristics of patients diagnosed with acromegaly in various stages of the disease. Int J Endocrinol (2018) 2018:6935054. doi: 10.1155/2018/6935054
8. dos Santos Silva CM, Gottlieb I, Volschan I, Kasuki L, Warszawski L, Balarini Lima GA, et al. Low frequency of cardiomyopathy using cardiac magnetic resonance imaging in an acromegaly contemporary cohort. J Clin Endocrinol Metab (2015) 100(12):4447–55. doi: 10.1210/jc.2015-2675
9. Tops LF, Delgado V, Marsan NA, et al. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail. 2017; 19(3): 307–313, doi: 10.1002/ejhf.694, indexed in Pubmed: 27891719
10. Isgaard J, Arcopinto M, Karason K, et al. GH and the cardiovascular system: an update on a topic at heart. Endocrine 2015;48(1):25–35.
11. Delafontaine P. Insulin like growth factor I and its binding proteins in the cardiovascular system. Cardiovasc Res 1995;30:825–34
12. Di Somma C, Scarano E, Savastano S, et al. Cardiovascular alterations in adult GH deficiency. Best Pract Res Clin Endocrinol Metab 2017;31(1)
13. Arcopinto M, Bobbio E, Bossone E, et al. The GH/IGF-1 axis in chronic heart failure. Endocrine 2015; 48(1):25–35
14. Standley PR, Zhang F, Zayas RM, et al. IGF-I regulation of Na(þ)-K(þ)-ATPase in rat arterial smooth muscle. Am J Physiol 1997;273:E113–21.
15. Haffner D, Grund A, Leifheit-Nestler M. Renal effects of growth hormone in health and in kidney disease. Pediatr Nephrol. 2021 Aug;36(8):2511-2530. doi: 10.1007/s00467-021-05097-6. Epub 2021 Jun 18. PMID: 34143299; PMCID: PMC8260426.
16. Ramos-Levi AM, Marazuela M. Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them? Front.Endocrinol. 2019 doi.org/10.3389/fendo.2019.00120
17. Yang H, Tan H, Huang H, Li J. Advances in research on the cardiovascular complications of acromegaly. Front Oncol (2021) 11:640999. doi: 10.3389/ fonc.2021.640999
18. Powlson AS, Gurnell M. Cardiovascular disease and sleep-disordered breathing in acromegaly. Neuroendocrinology. (2016) 103:75–85. doi: 10.1159/000438903
19. Huchard H. Anatomie pathologique, lesions et trouble cardiovasculaires de l’acromegalie. J Practiciens (1895) 9:249–50
20. Colao A, Grasso LFS, Di Somma C, Pivonello R. Acromegaly and Heart Failure. Heart Fail Clin. 2019 Jul;15(3):399-408. doi: 10.1016/j.hfc.2019.03.001. PMID: 31079698.
21. Ramos-Levı́ AM, Marazuela M. Cardiovascular comorbidities in acromegaly: an update on their diagnosis and management. Endocrine (2017) 55(2):346–59. doi: 10.1007/s12020-016-1191-3
22. Uziȩbło-Życzkowska B, Jurek A, Witek P, Zieliński G, Gielerak G, Krzesiński P.Left heart dysfunction in acromegaly revealed by novel echocardiographic methods.Front Endocrinol (Lausanne) (2020) 11:418. doi: 10.3389/fendo.2020.00418
23. Gadelha P, Santos ECL, Castillo J, Vilar L. Subclinical ventricular dysfunction in long-term acromegaly assessed by speckle-tracking echocardiography. Front Endocrinol (Lausanne) (2022) 13:812964. doi: 10.3389/fendo.2022.812964
24. Volschan ICM, Kasuki L, Silva CMS, Alcantara ML, Saraiva RM, Xavier SS, et al.Two-dimensional speckle tracking echocardiography demonstrates no effect of active acromegaly on left ventricular strain. Pituitary (2017) 20(3):349–57. doi: 10.1007/s11102-017-0795-9
25. Popielarz-Grygalewicz A, Stelmachowska-Banaś M, Raczkiewicz D, Czajka-Oraniec I, Zieliński G, Kochman W, Dąbrowski M and Zgliczyński W. Effects of acromegaly treatment on left ventricular systolic function assessed by speckle tracking echocardiography in relation to sex differences: results from a prospective single center study. Front. Endocrinol. 14:1154615 doi:10.3389/fendo.2023.1154615
26. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J (2016) 37(15):1196–207. doi: 10.1093/eurheartj/ehv529
27. Popielarz-Grygalewicz A, Stelmachowska-Banaś M, Gasior JS, Grygalewicz P, Czubalska M, Zgliczyński W, et al. Subclinical left ventricular systolic dysfunction in patients with naive acromegaly - assessment with two-dimensional speckle-tracking echocardiography: retrospective study. Endokrynol Pol (2020) 71(3):227–34. doi:10.5603/EP.a2020.0021
28. Lasocka Z, Lewicka-Potocka Z, Faran A, Daniłowicz-Szymanowicz L, Nowak R, Kaufmann D, et al. Exercise-induced atrial remodeling in female amateur marathon runners assessed by three-dimensional and speckle tracking echocardiography. Front Physiol (2022) 13:863217. doi: 10.3389/fphys.2022.863217
29. Carbone A, D'Andrea A, Riegler L, Scarafile R, Pezzullo E, Martone F, et al.Cardiac damage in athlete's heart: when the "supernormal" heart fails! World J Cardiol (2017) 9(6):470–80. doi: 10.4330/wjc.v9.i6.470
30. Parolin M, Dassie F, Vettor R, Steeds RP, Maffei P. Electrophysiological features in acromegaly: re-thinking the arrhythmic risk? J Endocrinol Invest. 2021 Feb;44(2):209-221. doi: 10.1007/s40618-020-01343-0. Epub 2020 Jul 6. PMID: 32632903.
31. Arias MA, Pachón M, Rodrıguez-Padial L. Ventricular tachycardia in acromegaly. Rev Port Cardiol (2011) 30:223–6. doi: 10.1016/S0196-0644 (99)70109-5
32. Subramnaian, M, Shah, V, Saggu, DK, Yalagudri, S, Narasimhan, C. Looking above the heart: A rare cause of ventricular tachycardia. J Arrhythmia. 2021; 37: 1120– 1122. https://doi.org/10.1002/joa3.12546
33. Heidarpour M, Shafie D, Aminorroaya A, Sarrafzadegan N, Farajzadegan Z, Nouri R, Najimi A, Dimopolou C, Stalla G. Effects of somatostatin analog treatment on cardiovascular parameters in patients with acromegaly: A systematic review. J Res Med Sci. 2019 Apr 26;24:29. doi: 10.4103/jrms.JRMS_955_18. PMID: 31143230; PMCID: PMC6521613.
34. Auriemma RS, Grasso LF, Galdiero M, Galderisi M, Pivonello C,Simeoli C, et al. Effects of long-term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance in acromegaly. Endocrine (2017) 553(3):872–84.doi: 10.1007/s12020-016-0995-5
35. Zgliczyński W, Zdunowski Pegvisomant — growth hormone receptor antagonist in the treatment of acromegaly /Polish Journal of Endocrinology Volume 58; Number 5/2007
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