From the Guidelines
Echocardiograms should be performed at diagnosis and then every 1-2 years for patients with acromegaly, depending on their cardiac status and disease control. At initial diagnosis, all patients should undergo a baseline echocardiogram to assess for cardiac abnormalities, as acromegaly commonly causes left ventricular hypertrophy, diastolic dysfunction, and valvular abnormalities [ 1 ]. For patients with active disease or existing cardiac complications, more frequent monitoring with annual echocardiograms is recommended. Those with well-controlled disease and normal cardiac function may be monitored less frequently, typically every 2 years. The frequency may need to be increased if new cardiac symptoms develop or if there are changes in disease activity.
Key Considerations
- The monitoring schedule is important because cardiovascular complications are a leading cause of morbidity and mortality in acromegaly, with up to 60% of patients developing some form of cardiac involvement [ 1 ].
- Growth hormone excess directly affects cardiac muscle, causing progressive structural and functional changes that can be detected and monitored through regular echocardiographic assessment.
- Recent guidelines for the management of hypertrophic cardiomyopathy also support the use of echocardiography for monitoring cardiac function, with recommendations for repeat transthoracic echocardiogram (TTE) every 1 to 2 years to assess the degree of myocardial hypertrophy, dynamic LVOTO, MR, and myocardial function [ 1 ].
- The use of echocardiography in patients with acromegaly is crucial for early detection and management of cardiac complications, which can improve morbidity, mortality, and quality of life outcomes.
Monitoring Frequency
- Patients with active disease or existing cardiac complications: every 1 year
- Patients with well-controlled disease and normal cardiac function: every 2 years
- Patients with new cardiac symptoms or changes in disease activity: more frequent monitoring may be necessary.
Conclusion is not needed as per the guidelines, the above information is sufficient to make a decision.
From the Research
Echo Frequency for Acromegaly Patients
The frequency of echocardiography (echo) for patients with acromegaly is not explicitly stated in the provided studies. However, the following points can be considered:
- Acromegaly is associated with various systemic complications, including cardiovascular diseases, which can be detected by echocardiography 2.
- Echocardiography can show typical cardiomyopathy features in acromegaly patients, such as left ventricular hypertrophy, diastolic and systolic dysfunction, and increased aortic root diameters 2.
- Ultrasound (US) features, including echocardiography, can play a key role in early detection of acromegaly in the presence of typical clinical features 2.
Considerations for Echo Frequency
Some considerations for determining the frequency of echo for acromegaly patients include:
- The presence of systemic complications, such as cardiovascular diseases, which may require more frequent monitoring 2.
- The effectiveness of treatment in controlling growth hormone and insulin-like growth factor 1 levels, which can impact the frequency of echo 3, 4.
- The individual patient's risk factors and disease severity, which can influence the need for more frequent or less frequent echo monitoring 5.
Available Studies
The available studies do not provide a specific recommendation for the frequency of echo for acromegaly patients. However, they highlight the importance of echocardiography in detecting systemic complications associated with acromegaly 2 and the need for individualized treatment approaches 3, 4, 5.