Echocardiography in endocrine disorders

Transcription

1 Echocardiography in endocrine disorders Tamás Forster University of Szeged, Hungary Declaration of interest: Nothing to declare related to this topic

2 Endocrine disorders n Excess hormone secretion n Hormone deficiency state n Caleb Hillier Parry XIXth century first decription of CV symptoms and endocrine disorder n Robert Graves 1835 similar observation

3 Hormones causing CV abnormality n hgh, igf-i n thyroxin n glycocorticoid, aldosteron n parathormone

4 Predominantly hypertrophic forms n Acromegaly n Hyperparathyroidism n Pheochromocytoma n Hyperthyroidism n Hypercorticism - Cushing s sy. n Hyperaldosterinism - Conn s sy. n Diabetes mellitus n Obesity

5 Predominantly dilated forms n Hypoparathyroidism n Hypothyrodism n Alcoholic cardiomyopathy

6 Acromegaly Cardiovascular abnormalities n Hypertension n Cardiomyopathy u hypertrophic u dilated n Atherosclerosis

7 Acromegaly n 11/25 patients had severe hypertrophy u 10 patients asymmetric u 1 patients concentric n 6/25 patients had dilated forms - burnt-out? n 8 patients with normal left ventricle Csanády, Int. J. Cardiol., 1983

8 Acromegaly 15-year follow up n 15 died - 9 hypertrophic, 4 dilated, 2 normal n 10/25 patients survived n systemic hypertension occured between survivors n IVS, PW, HI differed significantly Gyöngyösi, Orv. Hetil., 1995.

9 Survival of our patients Normal Dilated H ypertrophic yrs

10 Probability of survival 15-year follow up n Hypertrophic form 18 % n Dilated form 33 % n Normal heart 75 %

11 Treatments of acromegaly n Somatostatin Octreotid n Surgery n Radiotherapy n Dopamin agonist - cabergoline

12 Acromegaly n 38/78 pts 10-year follow up n hormonally active - futher hypertrophy n initially inactive, later activation - hypertrophy n initially active, succesfully treated - regression of hypertrophy Hradec, Am. J. Cardiol., 1993

13 Hypopituitarism n excess CV mortality n increased body fat n premature atherosclerosis n reduced LV mass, impaired EF n diastolic filling abnormality Colao, J Clin Endocrinol Metab, 2002

14 Pheochromocytoma n Half of pts with fixed hypertension, 10 % normotensives n LV hypertrophy with normal LV function n Pulmonary edema n Myocarditis dilated - reversible

15 Hyperparathyroidism n parathormon level increased n hypertension, hypertrophy - direct and indirect effect n high level of plasma Ca ++ - nephrocalcinosis n intracellular Ca ++ excess n norepinephrine, angiotensin II

16 Hyperthyroidism n tachycardia, hyperkinesis, (atrial fib.) n systolic hypertension n V1/V3 myosin isoenzyme shift n mild hypertrophy n mitral valve prolapse n exceptionally dilated form may be present

17 Cushing s syndrome, Conn s syndrome n increased circulating blood volume n hypernatraemia n hypertension, LVH n angiotensin II, asymmetric hypertrophy - Cushing

18 Hypoparathyroidism n low plasma parathormone level n low plasma Ca ++ and ionized Ca ++ level n low ejection fraction, dilated ventricle n reversible!!!

19 Hypoparathyroidism EF (% ) SeCa EDD (mm) 1 mmol/l days

20 Hypothyroidism n dilated heart, depressed myocardial contractility n bradycardia, hypotension n heart failure relatively infrequent n pericardial effusion

21 Diabetes mellitus n multifactorial - IHD, hypertension, metabolic effect n hypertrophic form - infants, reversible n dilated, myocardial dysfunction adults diabetic cardiomyopathy

22 Diabetes mellitus n Decreased CFR n Increased aortic stiffness (decreased distensibility) n CFR confers prognostic implications Nemes, Can J Cardiol, 2007 Nemes, Diab Res Clin Practice 2007

23 Obesity n hypertension (hyperinsulinemia, hyperlipiemia, obesity) metabolic sy n coronary artery disease n congestive heart failure (CO, RR)

24 Conclusions n hormonal disorders can lead to excess CV mortality n short-term and long-term prognosis of the patients can be established by echocardiography n routine echocardiographic examination is advised to all patients with endocrine and metabolic disorders n serial echocardiographic studies are advocated during treatment

25 Thank you for your attention!