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Assessment of cardiac autonomic functions by heart rate recovery, heart rate variability and QT dynamicity parameters in patients with acromegaly

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Abstract

Cardiovascular complications are the most common causes of morbidity and mortality in acromegaly. However, there is little data regarding cardiac autonomic functions in these patients. Herein, we aimed to investigate several parameters of cardiac autonomic functions in patients with acromegaly compared to healthy subjects. We enrolled 20 newly diagnosed acromegalic patients (55 % female, age:45.7 ± 12.6 years) and 32 age- and gender-matched healthy subjects. All participants underwent 24 h Holter recording. 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. Mean HRR1 (29.2 ± 12.3 vs 42.6 ± 6.5, p = 0.001), HRR2 (43.5 ± 15.6 vs 61.1 ± 10.8, p = 0.001) and HRR3 (46.4 ± 16.2 vs 65.8 ± 9.8, p = 0.001) values were significantly higher in control group. HRV parameters as, SDNN [standard deviation of all NN intervals] (p = 0.001), SDANN [SD of the 5 min mean RR intervals] (p = 0.001), RMSSD [root square of successive differences in RR interval] (p = 0.001), PNN50 [proportion of differences in successive NN intervals >50 ms] (p = 0.001) and high-frequency [HF] (p = 0.001) were significantly decreased in patients with acromegaly; but low frequency [LF] (p = 0.046) and LF/HF (p = 0.001) were significantly higher in acromegaly patients. QTec (p = 0.009), QTac/RR slope (p = 0.017) and QTec/RR slope (p = 0.01) were significantly higher in patients with acromegaly. Additionally, there were significant negative correlation of disease duration with HRR2, HRR3, SDNN, PNN50, RMSSD, variability index. Our study results suggest that cardiac autonomic functions are impaired in patients with acromegaly. Further large scale studies are needed to exhibit the prognostic significance of impaired autonomic functions in patients with acromegaly.

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References

  1. Lopez-Velasco R, Escobar-Morreale HF, Vega B, Villa E, Sancho JM, Moya-Mur JL, Garcia-Robles R (1997) Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension? J Clin Endocrinol Metab 82(4):1047–1053

    CAS  PubMed  Google Scholar 

  2. Clayton RN (2003) Cardiovascular function in acromegaly. Endocr Rev 24(3):272–277

    Article  CAS  PubMed  Google Scholar 

  3. Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK (1994) Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf) 41(1):95–102

    Article  CAS  Google Scholar 

  4. Colao A (2009) 5 Long-term acromegaly and associated cardiovascular complications: a case-based review. Best Pract Res Clin Endocrinol Metab 23(Suppl 1):S31–S38. doi:10.1016/S1521-690X(09)70006-5

    Article  PubMed  Google Scholar 

  5. Vitale G, Pivonello R, Lombardi G, Colao A (2004) Cardiovascular complications in acromegaly. Minerva Endocrinol 29(3):77–88

    CAS  PubMed  Google Scholar 

  6. Malliani A, Lombardi F, Pagani M, Cerutti S (1994) Power spectral analysis of cardiovascular variability in patients at risk for sudden cardiac death. J Cardiovasc Electrophysiol 5(3):274–286

    Article  CAS  PubMed  Google Scholar 

  7. Schwartz RS, Jaeger LF, Veith RC (1990) The thermic effect of feeding in older men: the importance of the sympathetic nervous system. Metabolism 39(7):733–737

    Article  CAS  PubMed  Google Scholar 

  8. Sosnowski M, Clark E, Latif S, Macfarlane PW, Tendera M (2005) Heart rate variability fraction–a new reportable measure of 24-hour R–R interval variation. Ann Noninvasive Electrocardiol 10(1):7–15. doi:10.1111/j.1542-474X.2005.00579.x

    Article  PubMed  Google Scholar 

  9. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, Takeda H, Inoue M, Kamada T (1994) Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 24(6):1529–1535

    Article  CAS  PubMed  Google Scholar 

  10. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS (1999) Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 341(18):1351–1357. doi:10.1056/NEJM199910283411804

    Article  CAS  PubMed  Google Scholar 

  11. Rodrigues EA, Caruana MP, Lahiri A, Nabarro JD, Jacobs HS, Raftery EB (1989) Subclinical cardiac dysfunction in acromegaly: evidence for a specific disease of heart muscle. Br Heart J 62(3):185–194

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Resmini E, Casu M, Patrone V, Murialdo G, Bianchi F, Giusti M, Ferone D, Minuto F (2006) Sympathovagal imbalance in acromegalic patients. J Clin Endocrinol Metab 91(1):115–120. doi:10.1210/jc.2005-1506

    Article  CAS  PubMed  Google Scholar 

  13. Andersson IJ, Barlind A, Nystrom HC, Olsson B, Skott O, Mobini R, Johansson M, Bergstrom G (2004) Reduced sympathetic responsiveness as well as plasma and tissue noradrenaline concentration in growth hormone transgenic mice. Acta Physiol Scand 182(4):369–378. doi:10.1111/j.1365-201X.2004.01368.x

    Article  CAS  PubMed  Google Scholar 

  14. Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK (2011) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly–2011 update. Endocr Pract 17(Suppl 4):1–44

    PubMed  Google Scholar 

  15. Lahiri MK, Kannankeril PJ, Goldberger JJ (2008) Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol 51(18):1725–1733. doi:10.1016/j.jacc.2008.01.038

    Article  PubMed  Google Scholar 

  16. Malik M, et al (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93(5):1043–1065

    Google Scholar 

  17. Kautzner J, Malik M (1997) QT interval dispersion and its clinical utility. Pacing Clin Electrophysiol 20(10 Pt 2):2625–2640

    Article  CAS  PubMed  Google Scholar 

  18. Zabel M, Portnoy S, Franz MR (1995) Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol 25(3):746–752. doi:10.1016/0735-1097(94)00446-W

    Article  CAS  PubMed  Google Scholar 

  19. Wright AD, Hill DM, Lowy C, Fraser TR (1970) Mortality in acromegaly. Q J Med 39(153):1–16

    CAS  PubMed  Google Scholar 

  20. Orme SM, McNally RJ, Cartwright RA, Belchetz PE (1998) Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom acromegaly study group. J Clin Endocrinol Metab 83(8):2730–2734

    CAS  PubMed  Google Scholar 

  21. Melmed S (2001) Acromegaly and cancer: not a problem? J Clin Endocrinol Metab 86(7):2929–2934

    Article  CAS  PubMed  Google Scholar 

  22. Thuesen L, Christensen SE, Weeke J, Orskov H, Henningsen P (1988) A hyperkinetic heart in uncomplicated active acromegaly. Explanation of hypertension in acromegalic patients? Acta Med Scand 223(4):337–343

    Article  CAS  PubMed  Google Scholar 

  23. Colao A, Marzullo P, Di Somma C, Lombardi G (2001) Growth hormone and the heart. Clin Endocrinol (Oxf) 54(2):137–154

    Article  CAS  Google Scholar 

  24. Akgul E, Tokgozoglu SL, Erbas T, Kabakci G, Aytemir K, Haznedaroglu I, Oto A, Kes SS (2010) Evaluation of the impact of treatment on endothelial function and cardiac performance in acromegaly. Echocardiography 27(8):990–996. doi:10.1111/j.1540-8175.2010.01179.x

    Article  PubMed  Google Scholar 

  25. Erbas T, Erbas B, Usman A, Bekdik CF (1992) Assessment of left ventricular dysfunction in acromegalic patients using radionuclide ventriculography parameters. Cardiology 80(3–4):172–179

    Article  CAS  PubMed  Google Scholar 

  26. Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25(1):102–152

    Article  CAS  PubMed  Google Scholar 

  27. Kahaly G, Olshausen KV, Mohr-Kahaly S, Erbel R, Boor S, Beyer J, Meyer J (1992) Arrhythmia profile in acromegaly. Eur Heart J 13(1):51–56

    CAS  PubMed  Google Scholar 

  28. Herrmann BL, Bruch C, Saller B, Ferdin S, Dagres N, Ose C, Erbel R, Mann K (2001) Occurrence of ventricular late potentials in patients with active acromegaly. Clin Endocrinol (Oxf) 55(2):201–207

    Article  CAS  Google Scholar 

  29. Delafontaine P (1995) Insulin-like growth factor I and its binding proteins in the cardiovascular system. Cardiovasc Res 30(6):825–834

    Article  CAS  PubMed  Google Scholar 

  30. Freestone NS, Ribaric S, Mason WT (1996) The effect of insulin-like growth factor-1 on adult rat cardiac contractility. Mol Cell Biochem 163–164:223–229

    Article  PubMed  Google Scholar 

  31. Rio GD, Velardo A, Mascadri C, Zalteri G, Papi G, Menozzi R, Giustina A (2000) Baseline and stimulated catecholamine secretion in normotensive patients with active acromegaly: acute effects of continuous octreotide infusion. Europ J Endocrinol/Europ Federat Endocrine Soc 142(2):179–186

    Article  CAS  Google Scholar 

  32. Rozenberg I, Manchon P, Sabatier C, Hazard J, Lhoste F (1985) Effects of thyrotrophin-releasing hormone on plasma catecholamine levels in acromegalics. Acta Endocrinol 109(1):19–24

    CAS  PubMed  Google Scholar 

  33. Jouven X, Empana JP, Schwartz PJ, Desnos M, Courbon D, Ducimetiere P (2005) Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med 352(19):1951–1958. doi:10.1056/NEJMoa043012

    Article  CAS  PubMed  Google Scholar 

  34. Galinier M, Vialette JC, Fourcade J, Cabrol P, Dongay B, Massabuau P, Boveda S, Doazan JP, Fauvel JM, Bounhoure JP (1998) QT interval dispersion as a predictor of arrhythmic events in congestive heart failure Importance of aetiology. Europ Heart J 19(7):1054–1062

    Article  CAS  Google Scholar 

  35. Chevalier P, Burri H, Adeleine P, Kirkorian G, Lopez M, Leizorovicz A, Andre-Fouet X, Chapon P, Rubel P, Touboul P (2003) Groupe d’Etude du Pronostic de l’Infarctus du, M.: qT dynamicity and sudden death after myocardial infarction: results of a long-term follow-up study. J Cardiovasc Electrophysiol 14(3):227–233

    Article  PubMed  Google Scholar 

  36. Marti V, Guindo J, Homs E, Vinoles X (1992) Bayes de Luna, A.: peaks of QTc lengthening measured in Holter recordings as a marker of life-threatening arrhythmias in postmyocardial infarction patients. Am Heart J 124(1):234–235

    Article  CAS  PubMed  Google Scholar 

  37. Mohamed AL, Yusoff K, Muttalif AR, Khalid BA (1999) Markers of ventricular tachyarrythmias in patients with acromegaly. Med J Malaysia 54(3):338–345

    CAS  PubMed  Google Scholar 

  38. Unubol M, Eryilmaz U, Guney E, Ture M, Akgullu C (2012) QT dispersion in patients with acromegaly. Endocrine. doi:10.1007/s12020-012-9828-3

    PubMed  Google Scholar 

  39. Hejtmancik MR, Bradfield JY Jr, Herrman GR (1951) Acromegaly and the heart: a clinical and pathologic study. Ann Intern Med 34(6):1445–1456

    Article  CAS  PubMed  Google Scholar 

  40. Lie JT (1980) Pathology of the heart in acromegaly: anatomic findings in 27 autopsied patients. Am Heart J 100(1):41–52

    Article  CAS  PubMed  Google Scholar 

  41. Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517. doi:10.1210/jc.2008-2421

    Article  CAS  PubMed  Google Scholar 

  42. Alexopoulou O, Bex M, Kamenicky P, Mvoula AB, Chanson P, Maiter D (2013) Prevalence and risk factors of impaired glucose tolerance and diabetes mellitus at diagnosis of acromegaly: a study in 148 patients. Pituitary. doi:10.1007/s11102-013-0471-7

    Google Scholar 

  43. American Diabetes Association (2011) Diagnosis and classification of diabetes mellitus. Diabetes Care 34(Suppl 1):S62–S69. doi:10.2337/dc11-S062

    Google Scholar 

  44. Vitale G, Pivonello R, Auriemma RS, Guerra E, Milone F, Savastano S, Lombardi G, Colao A (2005) Hypertension in acromegaly and in the normal population: prevalence and determinants. Clin Endocrinol (Oxf) 63(4):470–476. doi:10.1111/j.1365-2265.2005.02370.x

    Article  Google Scholar 

  45. Fedrizzi D, Rodrigues TC, Costenaro F, Scalco R, Czepielewski MA (2011) Hypertension-related factors in patients with active and inactive acromegaly. Arq Bras Endocrinol Metabol 55(7):468–474

    Article  PubMed  Google Scholar 

  46. Bondanelli M, Ambrosio MR (2001) degli Uberti, E.C.: pathogenesis and prevalence of hypertension in acromegaly. Pituitary 4(4):239–249

    Article  CAS  PubMed  Google Scholar 

  47. Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, Stevens M, Kempler P, Hilsted J, Tesfaye S, Low P, Valensi P (2011) Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabet Metab Res Rev. doi:10.1002/dmrr.1239

    Google Scholar 

  48. Vinik AI, Erbas T, Casellini CM (2013) Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabet Invest 4(1):4–18. doi:10.1111/Jdi.12042

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey

    Muhammet Dural, Giray Kabakcı, Kadri Murat Gürses, Lale Tokgözoğlu, Ali Oto, Ergün Barış Kaya, Hikmet Yorgun, Levent Şahiner & Kudret Aytemir

  2. Endocrinolgy Unit, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Neşe Çınar, Tomris Erbaş & Selçuk Dağdelen

  3. Cardiology Clinic, Kastamonu Münif İslamoğlu State Hospital, Kastamonu, Turkey

    Uğur Canpolat

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  1. Muhammet Dural
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Dural, M., Kabakcı, G., Çınar, N. et al. Assessment of cardiac autonomic functions by heart rate recovery, heart rate variability and QT dynamicity parameters in patients with acromegaly. Pituitary 17, 163–170 (2014). https://doi.org/10.1007/s11102-013-0482-4

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