Cardiomyopathy in patients with acromegaly - not truly a concern anymore?

Acromegaly is associated with increased mortality rates if not adequately treated. Cardiovascular and metabolic comorbidities are highly prevalent and have long been considered the main cause of death among patients with acromegaly. However, substantial advances in GH/IGF-I-lowering treatment, together with increased awareness and optimized management of other risk factors, have led to major improvements in mortality rates in the 2-3 past decades. Here we review the effects of chronic excessive GH/IGF-I production and the successful treatment of this condition on relevant classical cardiovascular risk factors. and on morphological and functional changes in the heart and discuss differences in reported prevalence rates over time according to different imaging methodologies used. While morphological alterations, i.e., myocardial hypertrophy as well as increased atrial and ventricular volumes, are common in patients with acromegaly, overt clinically relevant dysfunction is rare. Valvular cardiac disease and arrhythmia are also reviewed. Clinically relevant cardiomyopathy is currently less common than previously estimated. Recent epidemiological studies have shown that the risk of heart failure is comparable to that of the general population after adjusting for biochemical disease control and other risk factors.