Heart arrhythmias and conduction disorders in patients with acromegaly: the role of cardiac magnetic resonance imaging

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Abstract

Cardiovascular complications including arrhythmias and cardiac conduction disorders are one of the main reasons of high mortality rate in acromegaly, while they have not been well explored.

Aim. To estimate arrhythmias frequency in acromegaly, identify risk factors leading to the development of arrhythmia and cardiac conduction disorder, to determine the role of cardiac MRI in detecting structural and functional changes.

Materials and methods. A single-center prospective cohort study, which included 461 patients (151 men and 310 women) with acromegaly, was conducted. All the patients underwent a standard medical examination, including hormonal blood test, electrocardiogram, echocardiography, electrocardiogram daily monitoring. 18 patients with arrhythmias (11 men and 7 women) had cardiac MRI with gadolinium-based contrast.

Results. The results of our research show high frequency of arrhythmias and cardiac conduction disorders in patients with acromegaly – 42%. Most frequent kinds of arrhythmias and cardiac conduction disorders were sinus bradycardia – 19.1% of the cases and conduction disorders of bundle branch blocks – 14.5%. Men were more likely to suffer from arrhythmias and cardiac conduction disorders than women (54.2% and 37.4%, respectively, p=0.0005). Not acromegaly activity but duration of the disease was a main risk factor of arrhythmias and cardiac conduction disorders. Patients with arrhythmias had a long anamnesis of acromegaly (10 and 7 years, respectively, p=0.04). Meanwhile, cardiac conduction disorders were commonly observed in the patients who were treated with somatostatin analogs comparing to the patients who didn’t undergo this therapy (50% and 38.6% respectively, p=0.004). We showed that 61% of patients with acromegaly and cardiac conduction disorders who underwent magnetic resonance imaging (MRI) had the signs of myocardial fibrosis. The value of the ejection fraction of the left ventricle according to MRI was higher than with echocardiography (p=0.04).

Conclusion. Arrhythmias and cardiac conduction disorders are often observed in patients with acromegaly even with remission of the disease. High risk group need careful diagnostic and monitoring approaches. Cardiac MRI is the «gold» standard for visualization of structural and morphological changes in the heart. Use of cardiac MRI in acromegalic patients expands our understanding of arrhythmias and cardiac conduction disorders in this disease. There are no specific laboratory markers of diffuse myocardial fibrosis, and the role of myocardial fibrosis in the occurrence of cardiac arrhythmias and conduction disorders needs further studying.

About the authors

K. V. Melkozerov

Endocrinology Research Centre

Author for correspondence.
Email: melkozerovkv@gmail.com
ORCID iD: 0000-0002-7328-6316

к.м.н., врач-кардиолог отд-ния хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции отд. кардиологии и сосудистой хирургии

Russian Federation, Moscow

E. G. Przhiyalkovskaya

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0001-9119-2447

к.м.н., ст. науч. сотр. отд-ния нейроэндокринологии и остеопатий

Russian Federation, Moscow

N. V. Tarbaeva

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0001-7965-9454

к.м.н., зав. отд-нием компьютерной и магнитно-резонансной томографии

Russian Federation, Moscow

A. A. Almaskhanova

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0002-2320-2532

аспирант

Russian Federation, Moscow

M. D. Kuklina

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0001-5802-3000

к.м.н., зав. отд-нием функциональной диагностики

Russian Federation, Moscow

P. A. Alferova

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0002-8679-2859

к.м.н., врач-кардиолог отд. кардиологии и сосудистой хирургии, врач функциональной диагностики отд-ния функциональной диагностики

Russian Federation, Moscow

I. S. Gomova

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0001-6318-1345

к.м.н., врач-кардиолог отд. кардиологии и сосудистой хирургии, врач функциональной диагностики отд-ния функциональной диагностики

Russian Federation, Moscow

L. A. Belousov

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0003-4917-1743

врач-кардиолог отд. хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции отд. кардиологии и сосудистой хирургии

Russian Federation, Moscow

Z. E. Belaya

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0002-6674-6441

д.м.н., гл. науч. сотр., зав. отд-нием нейроэндокринологии и остеопатий

Russian Federation, Moscow

A. V. Vorontsov

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0003-3074-6930

д.м.н., проф., зав. отд. лучевой диагностики

Russian Federation, Moscow

V. Y. Kalashnikov

Endocrinology Research Centre

Email: melkozerovkv@gmail.com
ORCID iD: 0000-0001-5573-0754

чл.-кор. РАН, д.м.н., проф., зав. отд. кардиологии и сосудистой хирургии

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Types of heart rhythm and conduction disorders in patients with acromegaly (number of patients, percentage of 461 patients with acromegaly).

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3. Fig. 2. MRI of the heart of a patient with NPS in acromegaly. Gray arrows indicate diffuse-focal accumulation of contrast agent by the LV side wall, white arrows indicate diffuse accumulation of contrast agent by the endocardium of the left atrium and valves).

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