Acromegaly in Speckle Tracking Echocardiography—A New Cardiac Hypertrophy Phenotype? Case Report and Review

BACKGROUND: This study aims to provide a comprehensive overview of speckle tracking echocardiography (STE) findings in patients diagnosed with acromegaly, exploring a potential application for the differential diagnosis of cardiac hypertrophy and guiding clinicians in patient management. To our knowledge, this is the first review showcasing changes in the bull's-eye pattern in myocardial function after acromegaly treatment, suggesting a possible pattern in this aetiology of left ventricular hypertrophy. METHODS: A review of PubMed articles using the search term "speckle tracking echocardiography acromegaly" yielded 11 relevant papers published between 2017 and 2023. The final analysis evaluated each paper's substantial value and summarised pertinent information. A clinical case of myocardial strain changes before and after pharmacological and neurosurgical treatment is also described. RESULTS: The 11 analysed papers, with patient groups ranging from 19 to 50 individuals, revealed varying results in STE parameters between acromegalic and control groups. Left ventricular strain parameters were commonly assessed, showing discrepancies in different studies. Notably, the MAGYAR-Path Study emphasised left ventricular twist and radial strain abnormalities in acromegaly patients. Furthermore, the interplay between acromegaly and diabetes influenced myocardial function. Drug treatment with somatostatin receptor ligands demonstrated a favourable impact on left ventricular systolic function. The case study we describe in this manuscript showed changes in the posterior basal LV segment, which may be a specific pattern of acromegaly remodelling. Somatostatin therapy and neurosurgery led to the normalisation of global longitudinal strain (GLS) and improvement in myocardial work, as well as improved diastolic function, including enhanced left atrial strain (LAS) as well as a visible elastic recoil sign (ERS). CONCLUSIONS: While the available literature on STE in acromegaly is limited, our analysis suggests potential applications in differentiating hypertrophy aetiologies and monitoring cardiac function post-treatment. The results underscore the need for more interdisciplinary research to optimise patient management. The bull's-eye pattern with posterior basal segment strain impairment we describe may be used to differentiate this entity.