Speckle-tracking echocardiography reveals the synergistic impact of GH/IGF-1 excess and metabolic dysregulation on cardiac dysfunction in acromegaly.

PURPOSE: Cardiac involvement in acromegaly is traditionally attributed to GH/IGF-1 excess, yet the subclinical impact of disease activity and metabolic comorbidities remains inadequately quantified. This study aims to characterize subclinical myocardial dysfunction in acromegaly using speckle-tracking echocardiography (STE) and explore its associations with disease activity, metabolic parameters, and treatment status.

METHODS

In this cross-sectional study, 74 patients with acromegaly (39 females) underwent detailed clinical, biochemical, and STE evaluation. STE-derived parameters of myocardial strain and work were analyzed including global longitudinal strain (GLS), left ventricular systolic dyssynchrony (LVSD), and global wasted work (GWW), and global work efficiency (GWE). Stratification by sex, treatment (naïve/active/remission), and metabolic profile was performed. Multivariable linear regressions identified predictors of cardiac structure/function.

RESULTS

Male patients exhibited higher IGF-1 level, BMI, and more pronounced cardiac alterations than females (all p < 0.05). IGF-1 z-score was strongly correlated with cardiac structural indices (IVS thickness, r = 0.564; LVPW thickness, r = 0.431) and dysfunction (LVSD, r = 0.359; GWE, r = - 0.361; all p < 0.01). These associations were significantly potentiated in high-BMI and high-triglyceride-glucose (TyG) index subgroups. Patients achieving biochemical remission showed superior cardiac structure and function compared to untreated/active groups (p < 0.05). Multivariable linear regressions analysis identified IGF-1 z-score as an independent predictor of both LVPW thickness (β = 0.210, p = 0.045) and LVSD index (β = 2.249, p = 0.048), with BMI and male sex as additional predictors of LVPW thickening.

CONCLUSIONS

Subclinical cardiac dysfunction in acromegaly is driven by IGF-1, exacerbated by metabolic factors, and improved with remission. STE supports early risk stratification and integrated management.