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How to interpret assessment of left ventricular function by strain in acromegaly?
Como interpreter a avalição da função ventricular esquerda por strain na acromegália?
Thor Edvardsen
Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "197" "paginaFinal" => "198" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Thor Edvardsen" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Thor" "apellidos" => "Edvardsen" "email" => array:1 [ 0 => "thor.edvardsen@medisin.uio.no" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Como interpreter a avalição da função ventricular esquerda por <span class="elsevierStyleItalic">strain</span> na acromegália?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acromegaly is a rare disease and our knowledge of acromegalic cardiomyopathy is moderate.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It is, however, very important for cardiologists to know that cardiovascular disease accounts for more than 50% of all deaths in acromegaly. Typical findings in acromegalic cardiomyopathy that should alert us include concentric left ventricular (LV) hypertrophy and progressive systolic dysfunction. These patients also suffer from hypertension, coronary artery disease, arrhythmias and valvular disease.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> The other most common cardiovascular risk factors in these patients are diabetes mellitus and sleep apnea syndrome. It is therefore clear that these patients will need cardiological expertise in addition to support from endocrinologists.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies of myocardial function in acromegalic cardiomyopathy are welcome in order to increase our knowledge base, and the study by Kormányos et al. published in this issue of the <span class="elsevierStyleItalic">Journal</span> adds to our understanding of this disease, but it also raise some questions that merit a closer look.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Their main findings were LV hypertrophy and impaired LV diastolic function with preserved LV systolic dysfunction. LV systolic function was assessed by ejection fraction (EF) and different strain measures. Radial strain was enhanced compared to normals, while longitudinal and circumferential strains were similar to those in normal individuals.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The apparently divergent messages from their strain measures – enhanced radial thickening and normal longitudinal strain – call for comment. Patients with acromegaly had thicker septums and larger LV cavities than normal individuals. A thicker interventricular septum and posterior wall will normally lead to reduced LV longitudinal function, but this was not found in their study.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> The explanation may be that the thickness was not very pronounced, and that the larger LV cavity could compensate for this relationship.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Longitudinal strain is considered the most robust and reproducible form of strain, while radial strain is considered less reproducible when using two-dimensional imaging.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a> The authors used three-dimensional strain, which is still considered a research tool, and one should therefore be wary of drawing firm conclusions about the apparently enhanced radial function.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The results from Kormányos et al.’s study are seemingly different from those of another recent study on myocardial function in acromegaly. Popielarz-Grygalewicz et al. assessed 140 patients and found that global longitudinal strain (GLS) indicated marginally worse LV function compared to their control group.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Their patient characteristics were, however, different from the population of the study published here. Those patients had much thicker LV walls and were therefore at a more advanced stage in the progression of acromegalic cardiomyopathy. Their findings were also somewhat surprising, since GLS was only marginally lower and thus relatively intact, despite being significantly different from their controls. We will therefore need more studies of LV mechanics in acromegaly before we can apply myocardial strain in these patients. A finding of reduced myocardial function by strain and normal EF is normally considered an early sign of myocardial disease, whereas Kormányos et al. report normal strain despite other signs of diseased myocardium in their patients. Their findings of normal systolic strains are therefore positive for the acromegalic population in their cohort, but cannot of course be extrapolated to all patients with acromegaly. <span class="elsevierStyleSmallCaps">I</span> therefore recommend that treatment decisions following echocardiographic studies should be based on traditional measures until we have obtained more knowledge on how to interpret myocardial function by strain in acromegaly.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acromegalic cardiomyopathy: an overview of risk factors clinical manifestations, and therapeutic options" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.D. Goldberg" 1 => "N. Vadera" 2 => "S. Yandrapalli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CRD.0000000000000215" "Revista" => array:6 [ "tituloSerie" => "Cardiol Rev" "fecha" => "2018" "volumen" => "26" "paginaInicial" => "307" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29794808" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) database" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Petrossians" 1 => "A.F. Daly" 2 => "E. Natchev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/ERC-17-0253" "Revista" => array:6 [ "tituloSerie" => "Endocr Relat Cancer" "fecha" => "2017" "volumen" => "24" "paginaInicial" => "505" "paginaFinal" => "518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28733467" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Active acromegaly is associated with enhanced left ventricular contractility: results from the three dimensional speckle-tracking echocardiographic MAGYAR-Path Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Á. Kormányos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2019.08.010" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol." "fecha" => "2020" "volumen" => "39" "paginaInicial" => "189" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32471666" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Geometry as a confounder when assessing ventricular systolic function: comparison between ejection fraction and strain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.M. Stokke" 1 => "N.E. Hasselberg" 2 => "M.K. Smedsrud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2017.06.046" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2017" "volumen" => "70" "paginaInicial" => "942" "paginaFinal" => "954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28818204" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EACVI-ASE-Industry Standardization Task Force. Variability and reproducibility of segmental longitudinal strain measurement: a report from the EACVI-ASE strain standardization task force" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O. Mirea" 1 => "E.D. Pagourelias" 2 => "J. Duchenne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2017.01.027" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2018" "volumen" => "11" "paginaInicial" => "15" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28528147" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging assessment of ventricular mechanics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Edvardsen" 1 => "K.H. Haugaa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart Br Card Soc" "fecha" => "2011" "volumen" => "97" "paginaInicial" => "1349" "paginaFinal" => "1356" "itemHostRev" => array:3 [ "pii" => "S016503271732534X" "estado" => "S300" "issn" => "01650327" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The thorny way of 3D strain from research to clinical use: are we getting closer?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Edvardsen" 1 => "K.H. Haugaa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2015.01.005" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "246" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25772831" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart in acromegaly: the echocardiographic characteristics of patients diagnosed with acromegaly in various stages of the disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Popielarz-Grygalewicz" 1 => "J.S. Gąsior" 2 => "A. Konwicka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Endocrinol" "fecha" => "2018" "volumen" => "2018" "paginaInicial" => "0546935" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003900000004/v1_202010170736/S2174204920301719/v1_202010170736/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003900000004/v1_202010170736/S2174204920301719/v1_202010170736/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920301719?idApp=UINPBA00004E" ]
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| 2024 July | 39 | 29 | 68 |
| 2024 June | 32 | 20 | 52 |
| 2024 May | 24 | 11 | 35 |
| 2024 April | 23 | 25 | 48 |
| 2024 March | 24 | 20 | 44 |
| 2024 February | 22 | 27 | 49 |
| 2024 January | 19 | 16 | 35 |
| 2023 December | 20 | 28 | 48 |
| 2023 November | 35 | 23 | 58 |
| 2023 October | 11 | 13 | 24 |
| 2023 September | 18 | 21 | 39 |
| 2023 August | 13 | 16 | 29 |
| 2023 July | 12 | 12 | 24 |
| 2023 June | 19 | 11 | 30 |
| 2023 May | 33 | 26 | 59 |
| 2023 April | 22 | 4 | 26 |
| 2023 March | 24 | 16 | 40 |
| 2023 February | 21 | 18 | 39 |
| 2023 January | 18 | 12 | 30 |
| 2022 December | 25 | 20 | 45 |
| 2022 November | 29 | 21 | 50 |
| 2022 October | 23 | 22 | 45 |
| 2022 September | 21 | 33 | 54 |
| 2022 August | 17 | 33 | 50 |
| 2022 July | 21 | 38 | 59 |
| 2022 June | 14 | 23 | 37 |
| 2022 May | 20 | 24 | 44 |
| 2022 April | 19 | 31 | 50 |
| 2022 March | 22 | 43 | 65 |
| 2022 February | 23 | 33 | 56 |
| 2022 January | 12 | 25 | 37 |
| 2021 December | 21 | 33 | 54 |
| 2021 November | 23 | 28 | 51 |
| 2021 October | 28 | 44 | 72 |
| 2021 September | 15 | 30 | 45 |
| 2021 August | 20 | 30 | 50 |
| 2021 July | 14 | 23 | 37 |
| 2021 June | 19 | 30 | 49 |
| 2021 May | 25 | 51 | 76 |
| 2021 April | 66 | 37 | 103 |
| 2021 March | 31 | 16 | 47 |
| 2021 February | 17 | 14 | 31 |
| 2021 January | 26 | 27 | 53 |
| 2020 December | 41 | 20 | 61 |
| 2020 November | 18 | 10 | 28 |
| 2020 October | 22 | 9 | 31 |
Show all
