P445Longitudinal left ventricular function and torsion by speckle-tracking echocardiography are decreased in adults with growth hormone deficiency.


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Abstract

We proved, by conventional and tissue Doppler echo, that left ventricular (LV) longitudinal dysfunction is present in adults with growth hormone deficiency (GHD) (abstract ESC 2011). Hereby, we use 2D speckle-tracking echo (STE) to assess separately longitudinal, radial, circumferential, and torsion functions, in GHD, by comparison with normal individuals.Methods: 30 GHD patients (46±14 years, 18 males), free of any cardiovascular disease or diabetes, matched (for age, sex, and cardiovascular risk profile) with a group of 30 normals (N), were studied by STE. Longitudinal LV function was assessed from: global longitudinal strain (GLS) and average time-to-peak strain (TGLS), and time from the AVC to peak strain (TAVC) and the sum of TAVC for those segments with post-systolic shortening; radial function from: global radial strain (GRS); circumferential function from: global circumferential strain (GCS); and LV torsion from: peak basal (RotB) and apical rotation (RotA), and derived times (time to RotB, time to RotA), LV torsion (LVtor), twist rate (TR), untwist rate (UTR), time-to-peak twist (TT), and time from the AVC to UTR (AVC-UTR).Results: GHD patients had significantly decreased longitudinal and circumferential LV functions, but similar radial function (table). They also had lower torsion (RotB, LV torsion, TR, and UTR) with prolonged AVC-UTR, but similar apical rotation (10.5±4.7 vs. 11.7±6.3) and similar times to RotB, RotA, and TT (322±74 vs. 319 ± 65; 354±55 vs. 341±59; 344±55 vs. 329±69, respectively). RotB correlated with GLS (r=0.4, p=0.002), which is not surprising, since basal rotation is due mainly to the longitudinal fibers. GHD patients had also LV dyssynchrony (TGLS, SumTAVC).Conclusions: GHD patients have subclinical longitudinal and circumferential LV dysfunction, with maintained radial function. These were correlated with impaired basal rotation, LV torsion, LV twist rate, and untwist rate, whereas apical rotation was preserved, probably as a compensatory mechanism. These findings prove that GHD is an intrinsic myocardial disease, which can be detected early by STE.

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