Assessment of the Left Ventricular Dysfunction in Patients With Acromegaly Using Global Longitudinal Strain by Two-Dimensional Speckle Tracking Echocardiography and Tissue Doppler Imaging

Introduction Acromegaly is a rare disease resulting from excess growth hormone (GH) and insulin-like growth factor-1 (IGF1), with cardiovascular complications being frequently encountered, leading to increased morbidity and mortality. The aim of the study was to determine the frequency of left ventricular systolic dysfunction in patients with acromegaly using global longitudinal strain (GLS) by 2D speckle tracking echocardiography and also the frequency of left ventricular diastolic dysfunction by tissue Doppler imaging (TDI). Materials and method A cross-sectional study involving 20 acromegaly patients with normal left ventricular (LV) systolic function as measured by ejection fraction and 20 controls with age, sex, and comorbidities matched were included in the study from 2021 to 2023. All these patients underwent 2D speckle tracking echocardiography to assess GLS and TDI with conventional 2D Echocardiography to assess diastolic function. Results GLS was significantly lower in the acromegaly group, which was -15.79±2.54 (mean±SD), than in the control group, which was -17.47±0.98 (mean±SD) with p < 0.05, indicating significant LV systolic dysfunction in the acromegaly group. The majority of the acromegaly group had abnormal GLS (n=11; 55%). The majority of the acromegaly patients with increased left atrial volume index (LAVi) had abnormal GLS (n=8/11; 72.7%). Also, the majority of the acromegaly patients with increased LVMi had abnormal GLS (n=8/12; 66.66%). TDI study for diastolic dysfunction showed no significant difference between the acromegaly group and the control group (p > 0.05). LAVi in the acromegaly group was 31.35±6.22 (mean±SD), and in the control group was 27.00±4.81(mean±SD) with p < 0.05, which was statistically significant. LAVi was more in the active acromegaly group (4 males and 2 females) than inactive acromegaly group (3 males and 2 females). LVMi in the acromegaly group was 100.32±24.335 (mean±SD), and in the control group, it was 85.85±19.63 (mean±SD) with p < 0.05, indicating more LV hypertrophy. LVMi was more in the active (5 females and 4 males) than the inactive acromegaly group (2 females and 1 male). Statistical significance was observed in LVID between the acromegaly group, which was 4.75±0.52 (mean±SD), and the control group, which was 4.41±0.49 (mean±SD) with a p < 0.05. Septal medial early diastolic velocity (e` med) in the acromegaly group was 0.08±0.03 (mean±SD), and in the control group was 0.10±0.02 (mean±SD) with p < 0.05, which was statistically significant. The multiple linear regression analysis revealed that acromegaly, hypertension, and higher body surface were the most important predictors of abnormal GLS. Conclusions Abnormal GLS indicating subclinical LV systolic dysfunction in patients with acromegaly can be evaluated by 2D speckle tracking echocardiography. Active acromegaly patients had more abnormal GLS, increased LAVi, and increased LVMi than inactive acromegaly patients. LV diastolic dysfunction was not remarkable when the acromegaly group and control group were assessed as the comorbidities were matched. The presence of acromegaly, hypertension, and higher body surface area had a significant negative effect on GLS.