Diagnostic and prognostic value of myocardial work indices in evaluating cardiac function damage in active acromegaly patients.

Objective: Strain imaging serves as a sensitive marker for detecting early subclinical myocardial systolic dysfunction. The purpose of this study was to evaluate the diagnostic and prognostic value of myocardial work indices in assessing subclinical myocardial systolic dysfunction in active acromegaly patients. Methods: 27 active acromegaly patients and 27 healthy controls matched for age, sex, height, weight, body mass index and body surface area were included in the study. Active acromegaly was diagnosed based on elevated serum insulin-like growth factor 1 (IGF-1) (>1× upper limit of normal) or insufficient GH suppression (nadir ≥0.4 ng/mL) during an OGTT. All participants underwent two-dimensional speckle-tracking echocardiography (2D-STE) for the assessment of cardiac function. STE extracted the corresponding strain parameters (such as global longitudinal strain (GLS), global circumferential strain and global radial strain) and work parameters (such as global work index, global constructive work, global wasted work (GWW) and global work efficiency (GWE)) by analyzing the motion (strain)-velocity (strain rate) of two or more local myocardial segments, combined with the left ventricular non-invasive pressure estimation technique. At the same time, correlation analysis was used to explore the factors affecting GWW and GWE in the acromegaly group. Results: In comparison with the control group, conventional echocardiography revealed that acromegaly patients did not exhibit a significant difference in left ventricular ejection fraction (60.3 ± 3.7 vs 59.1 ± 4.8, P = 0.312), a commonly used index to evaluate ventricular systolic function, STE showed that there was no significant difference in GLS (-18.3 ± 2.4 vs -17.4 ± 2.9, P = 0.514) between the control group and the acromegaly group. However, significant differences can be found in GWW (44.8 ± 31.1 vs 80.6 ± 75.6, P = 0.027) and GWE (97.0 ± 1.8 vs 95.0 ± 3.8, P = 0.020), and a significant correlation was observed between myocardial work parameters and 1.5 × ULN IGF-1. Conclusion: GWW and GWE are sensitive markers for identifying subclinical myocardial systolic dysfunction, suggesting their potential as early markers for detecting subclinical myocardial systolic dysfunction in active acromegaly patients.