Correlations between Arteriograph-Derived Augmentation Index and Disease Activity in Acromegaly Patients.

Year 2020, Volume: 6 Issue: 3, 376 - 384, 31.12.2020

Seçkin Dereli , Canan Ersoy , Ali Aydınlar

https://doi.org/10.19127/mbsjohs.764508

Abstract

Objective: The high prevalence of cardiovascular diseases in acromegaly patients attracted attention to the association between the growth hormone and cardiovascular system. New markers such as the augmentation index (AIx) and central aortic pressure (CAP) have recently been introduced to the clinical practice for a variety of diagnostic and monitoring purposes in predicting arterial stiffness and associated endothelial dysfunction. In this present study, we aimed to determine the condition of the vascular system using the non-invasive arterial stiffness marker; AIx measured using by the Arteriograph device and to evaluate the relationship between these markers and the disease activity in acromegaly patients.
Methods: This was a cross-sectional study. The study included 53 acromegaly patients and 20 individuals age and sex matched as controls. The arterial stiffness was evaluated to estimate the AIx and CAP with a low-frequency suprasystolic waveform analysis in the occluded brachial artery, performed by using a Cardio Scope II Arteriograph device, which was adapted from a standard sphygmomanometer.
Results: The mean augmentation index was statistically significantly different between the three groups, being 98% in the active acromegaly (AA) group, 92% in controlled acromegaly (CA) and 79.5% in the control group (p=0.001). In the acromegaly group, the results of the regression analysis indicated a strong correlation of the arterial stiffness parameters with HbA1c and the platelet counts, however, the levels of IGF-1 and GH were not correlated
Conclusion: It might be thought that AIx may have an important role in predicting the cardiovascular risk in acromegaly.

Keywords

acromegaly, arterial stiffness, disease activity, Augmentation index,

References

• Baykan M, Erem C, Gedikli O, Hacihasanoglu A, Erdogan T, Kocak M, et al. Impairment in flow-mediated vasodilatation of the brachial artery in acromegaly. Med Princ Pract. 2009;18(3):228-232. doi:10.1159/000204355
• Bengtsson BA, Edén S, Ernest I, Odén A, Sjögren B. Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984. Acta Med Scand. 1988;223(4):327-335. doi:10.1111/j.0954-6820.1988.tb15881.x
• Carmichael JD, Bonert VS, Mirocha JM, Melmed S. The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly. Clin Endocrinol Metab. 2009;94(2):523-527. doi:10.1210/jc.2008-1371
• Cavero-Redondo I, Martínez-Vizcaíno V, Álvarez-Bueno C, Recio-Rodríguez JI, Gómez-Marcos MÁ, García-Ortiz L. Relationship between glycaemic levels and arterial stiffness in non-diabetic adults. Relación entre los valores de glucemia y la rigidez arterial en adultos no diabéticos. Med Clin (Barc). 2018;150(2):56-60. doi:10.1016/j.medcli.2017.06.072.
• Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller BMed OI, Sullivan Fracp ID. et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340(8828):1111-1115. doi:10.1016/0140-6736(92)93147-f.
• Colao A, Marzullo P, Di Somma C, Lombardi G. Growth hormone and the heart. Clin Endocrinol (Oxf). 2001;54(2):137-154. doi:10.1046/j.1365-2265.2001.01218.x.
• Colao A, Spiezia S, Cerbone G, Pivonella R, Marzullo P, Ferone D. et al. Increased arterial intima-media thickness by B-M mode echodoppler ultrasonography in acromegaly. Clin Endocrinol (Oxf). 2001;54(4):515-524. doi:10.1046/j.1365-2265.2001.01256.x.
• Davies JI, Struthers AD. Pulse wave analysis and pulse wave velocity: a critical review of their strengths and weaknesses. J Hypertens. 2003;21(3):463-472. doi:10.1097/00004872-200303000-00004.
• Eguchi K, Hoshide S, Miyashita H, Nagasaka S, Kario K. Why the radial augmentation index is low in patients with diabetes: The J-HOP study. Atherosclerosis. 2016;246:338-343. doi:10.1016/j.atherosclerosis.2016.01.034. Fischer-Rasokat U, Brenck F, Zeiher AM, Spyridopoulos I. Radial augmentation index unmasks premature coronary artery disease in younger males. Blood Press Monit. 2009;14(2):59-67. doi:10.1097/MBP.0b013e32832941ce.
• García-Ortiz L, Recio-Rodríguez JI, Agudo-Conde C, Mandereuelo-Fernandez JA, Patino-Alonso MC, Cabo-Laso A, et al. Noninvasive validation of central and peripheral augmentation index estimated by a novel wrist-worn tonometer. J Hypertens. 2018;36(11):2204-2214. doi:10.1097/HJH.0000000000001806
• Izzo JL Jr. Arterial stiffness and the systolic hypertension syndrome. Curr Opin Cardiol. 2004;19(4):341-352. doi:10.1097/01.hco.0000126581.89648.10.
• Izzo JL Jr. Brachial vs. central systolic pressure and pulse wave transmission indicators: a critical analysis. Am J Hypertens. 2014;27(12):1433-1442. doi:10.1093/ajh/hpu135.
• Laurent S, Cockcroft J, Van Bortel L, BoutouyrieP, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588-2605. doi:10.1093/eurheartj/ehl254.
• Lee YH, Shin MH, Choi JS, Rhee JA, Nam HS, Jeong SK, et al. HbA1c is significantly associated with arterial stiffness but not with carotid atherosclerosis in a community-based population without type 2 diabetes: The Dong-gu study. Atherosclerosis. 2016;247:1-6. doi:10.1016/j.atherosclerosis.2016.01.032.
• Lin AC, Lowe A, Sidhu K, Harrison W, Ruygrok P, Stewart R. Evaluation of a novel sphygmomanometer, which estimates central aortic blood pressure from analysis of brachial artery suprasystolic pressure waves. J Hypertens. 2012;30(9):1743-1750. doi:10.1097/HJH.0b013e3283567b94.
• London GM, Blacher J, Pannier B, Guérin AP, Marchais SJ, Safar ME. Arterial wave reflections and survival in end-stage renal failure. Hypertension. 2001;38(3):434-438. doi:10.1161/01.hyp.38.3.434.
• Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol. 2013;75(1):79-92. doi:10.1111/j.1365-2125.2012.04342.x. Matsuda Y, Kawate H, Matsuzaki C, Sakamoto R, Abe I, Shibue K. et al. Reduced arterial stiffness in patients with acromegaly: non-invasive assessment by the cardio-ankle vascular index (CAVI). Endocr J. 2013;60(1):29-36. doi:10.1507/endocrj.ej12-0189.
• Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018 Sep;14(9):552-561. doi: 10.1038/s41574-018-0058-5.. Morvan D, Komajda M, Grimaldi A, Turpin G, Grosgogeat Y. Cardiac hypertrophy and function in asymptomatic acromegaly. Eur Heart J. 1991;12(6):666-672.
• Neunteufl T, Heher S, Katzenschlager R, Wölfl G, Kostner K, Maurer G, Weidinger F. Late prognostic value of flow-mediated dilation in the brachial artery of patients with chest pain. Am J Cardiol. 2000;86(2):207-210. doi:10.1016/s0002-9149(00)00857-2. Nichols WW. Clinical measurement of arterial stiffness obtained from noninvasive pressure waveforms. Am J Hypertens. 2005;18(1 Pt 2):3S-10S. doi:10.1016/j.amjhyper.2004.10.009.
• Paisley AN, Banerjee M, Rezai M, Schofield RE, Balakrishnannair S, Herbert A, et al. Changes in arterial stiffness but not carotid intimal thickness in acromegaly. J Clin Endocrinol Metab. 2011;96(5):1486-1492. doi:10.1210/jc.2010-2225.
• Parolin M, Dassie F, Martini C, Mioni R, Russo L, Fallo F, et al. Preclinical markers of atherosclerosis in acromegaly: a systematic review and meta-analysis. Pituitary. 2018;21(6):653-662. doi:10.1007/s11102-018-0911-5.
• Pokrajac A, Wark G, Ellis AR, Wear J, Wieringa GE, Trainer PJ. Variation in GH and IGF-I assays limits the applicability of international consensus criteria to local practice. Clin Endocrinol (Oxf). 2007;67(1):65-70. doi:10.1111/j.1365-2265.2007.02836.x.
• Rosenbaum D, Giral P, Chapman J, Rached FH, Kahn JF, Bruckert E, et al. Radial augmentation index is a surrogate marker of atherosclerotic burden in a primary prevention cohort. Atherosclerosis. 2013;231(2):436-441. doi:10.1016/j.atherosclerosis.2013.10.004. Sakai H, Tsuchiya K, Nakayama C, Iwashima F, Izumiyama H, Doi M, et al. Improvement of endothelial dysfunction in acromegaly after transsphenoidal surgery. Endocr J. 2008;55(5):853-859. doi:10.1507/endocrj.k07e-125.
• Smith JC, Lane H, Davies N, Evans LM, Cockcroft J, Scanlon MF, et al. The effects of depot long-acting somatostatin analog on central aortic pressure and arterial stiffness in acromegaly. J Clin Endocrinol Metab. 2003;88(6):2556-2561. doi:10.1210/jc.2002-021746.
• Sowers JR. Insulin and insulin-like growth factor in normal and pathological cardiovascular physiology. Hypertension. 1997;29(3):691-699. doi:10.1161/01.hyp.29.3.691.
• Tan KC, Shiu SW, Janus ED, Lam KS. LDL subfractions in acromegaly: relation to growth hormone and insulin-like growth factor-I. Atherosclerosis. 1997;129(1):59-65. doi:10.1016/s0021-9150(96)06015-7.
• Trainer PJ, Drake WM, Katznelson L, Freda PU, Herman-Bonert V, van der Lely AJ, et al. Treatment of acromegaly with the growth hormone–receptor antagonist pegvisomant. N Engl J Med 2000; 342:1171-1177 DOI: 10.1056/NEJM200004203421604.
• Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834-1840. doi:10.1056/NEJMoa021375.
• Walsh MF, Barazi M, Pete G, Muniyappa R, Dunbar JC, Sowers JR. Insulin-like growth factor I diminishes in vivo and in vitro vascular contractility: role of vascular nitric oxide. Endocrinology. 1996;137(5):1798-1803. doi:10.1210/endo.137.5.8612517.
• Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Berent R et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004;109(2):184-189. doi:10.1161/01.CIR.0000105767.94169.E3.
• Yaron M, Izkhakov E, Sack J, Azzam I, Osher E, Tordjman K, et al. Arterial properties in acromegaly: relation to disease activity and associated cardiovascular risk factors. Pituitary. 2016;19(3):322-331. doi:10.1007/s11102-016-0710-9.