Severe myocardial hypertrophy and fibrosis in a patient with acromegaly: is the prevention of sudden cardiac death needed?

The most common causes of death in acromegaly are cardiovascular diseases (about 60%). Heart arrhythmias and conduction disorders lead to sudden cardiac death (SCD). In this article, we described a clinical case about preventing SCD in a patient with acromegaly. We identified in this patient predictors of SCD: severe left ventricular hypertrophy, the signs of myocardial fibrosis, decreased systolic function of the left ventricular myocardium, ventricular rhythm disturbances, and heart failure. Patients with acromegaly have higher risk of heart arrhythmias due to development acromegalic cardiomyopathy with includes: left ventricular hypertrophy, diastolic and systolic dysfunction, myocardial fibrosis and electrical disturbances of the myocardium. The main limitation is the lack of special clinical recommendations for the management of this group of patients. Current recommendations based on a standard algorithm and do not consider specificity of acromegalic cardiomyopathy.

1. Zaman S, Goldberger JJ, Kovoor P. Sudden Death Risk-Stratification in 2018-2019: The Old and the New. Heart Lung Circ. 2019;28(1):57-64. DOI:10.1016/j.hlc.2018.08.027.

2. Sharma MD, Nguyen AV, Brown S, Robbins RJ. Cardiovascular Disease in Acromegaly. Methodist Debakey Cardiovascular J. 2017;13(2):64-7. doi:10.14797/mdcj-13-2-64.

3. Gadelha MR, Kasuki L, Lim DS, 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.

4. Sharma AN, Tan M, Amsterdam EA, Singh GD. Acromegalic cardiomyopathy: Epidemiology, diagnosis, and management. Clin Cardiol. 2018;41(3):419-25. DOI:10.1002/clc.22867.

5. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004;25(1):102-52. DOI:10.1210/er.2002-0022.

6. Arias MA, Pachón M, Rodríguez-Padial L. Ventricular tachycardia in acromegaly. Rev Port Cardiol. 2011;30(2):223-6.

7. Lebedev DS, Mikhailov EN, Neminuschiy NM, et al. Ventricular arrhythmias. Ventricular tachycardias and sudden cardiac death. 2020 Clinical guidelines. Russian Journal of Cardiology. 2021;26(7):4600 (In Russ.) DOI:10.15829/1560-4071-2021-4600.

8. Yokota F, Arima H, Hirano M, et al. Normalisation of plasma growth hormone levels improved cardiac dysfunction due to acromegalic cardiomyopathy with severe fibrosis. BMJ Case Rep. 2010;2010:bcr1220092559. DOI:10.1136/bcr.12.2009.2559.

9. An Z, He YQ, Liu GH, et al. Malignant ventricular tachycardia in acromegaly: a case report. Sao Paulo Med J. 2015;133(1):55-9. DOI:10.1590/1516-3180.2012.6410005.

10. Parolin M, Dassie F, Vettor R, et al. Electrophysiological features in acromegaly: re-thinking the arrhythmic risk? J Endocrinol Invest. 2021;44(2):209-21. DOI:10.1007/s40618-020-01343-0.

11. Rodrigues EA, Caruana MP, Lahiri A, et al. Subclinical cardiac dysfunction in acromegaly: evidence for a specific disease of heart muscle. Br Heart J. 1989;62(3):185-94. DOI:10.1136/hrt.62.3.185.

12. Kahaly G, Olshausen KV, Mohr-Kahaly S, et. al. Arrhythmia profile in acromegaly. Eur Heart J. 1992;13(1):51-6. DOI:10.1093/oxfordjournals.eurheartj.a060047.

13. Melkozerov KV, Przhiyalkovskaya EG, Tarbaeva NV, et.al. Heart arrhythmias and conduction disorders in patients with acromegaly: the role of cardiac magnetic resonance imaging. Ter Arkh. 2020;92(10):70-7 (In Russ.) DOI:10.26442/00403660.2020.10.000787.

14. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al; ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997-4126. DOI:10.1093/eurheartj/ehac262.

15. Guo X, Fu H, Pang H, Xing B. Risk of left ventricular hypertrophy and diastolic and systolic dysfunction in Acromegaly: A meta-analysis. J Clin Neurosci. 2018;48:28-33. DOI:10.1016/j.jocn.2017.10.067.