Evaluation of cardiac structure by echoreflectivity analysis in acromegaly: effects of treatment

Objectives: Cardiac echoreflectivity is a noninvasive tool for evaluating cardiac fibrosis. The present paper aimed to study the modifications of cardiac echoreflectivity in a group of acromegalic patients before and after therapy, and to assess possible correlations with serum levels of procollagen III (PIIINP), a peripheral index of collagen synthesis. Design and methods: Cardiac echoreflectivity (as assessed by analyzing 2-D echocardiograms digitized off-line onto a personal computer) and PIIINP levels were evaluated in 16 acromegalic patients of new diagnosis not affected by arterial hypertension (10 males, six females, age+/-S.D.: 38+/-10 years), and in a group of 16 sex- and age-matched healthy subjects. All the patients were re-evaluated after surgical and/or medical therapy for acromegaly. The echo patterns were analyzed by software that supplies the derived collagen volume fraction (dCVF), an index of fibrosis. Results: At baseline, acromegalic patients showed significantly higher dCVF values and PIIINP levels than healthy controls (3.1 +/- 0.5% vs 1.6 +/- 0.3%, P < 0.01 and 8.7 +/- 2.2 vs 3.1 +/- 1.1 ng/ml, P < 0.05, respectively, by unpaired Student's t-test). After therapy, dCVF and PIIINP levels normalized in the six controlled patients (that is, GH of < 2.5 mug/l and IGF-I within normal range) (dCVF from 2.8 +/- 0.4% to 1.4 +/- 0.2%. P < 0.001; PIIINP from 8 +/- 2.7 to 3.3 +/- 1.9 ng/ml, P < 0.05), while no significant changes were found in noncontrolled patients (dCVF from 3.3 +/- 0.6% to 2.9 +/- 1.2% and PIIINP from 9.1 +/- 1.9 to 7.9 +/- 3.5 ng/ml, P = NS). A positive correlation between dCVF and PIIINP (r = 0.75. P < 0.001) and between IGF-I and both dCVF and PIIINP (r = 0.65 and 0.61 respectively, P < 0.05) was found in acromegalic patients. Conclusions: Cardiac echoreflectivity, which may be a reflection of heart collagen content, is increased m patients with active acromegaly and correlates with PIIINP concentrations. After cure or adequate control of the disease, both parameters revert to normal. Echoreflectivity analysis could be a useful adjuvant parameter in the assessment of the activity of acromegalic disease.