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Background: Acromegaly is associated with an increased mortality mainly due to cardiovascular causes. Aim: to evaluate the eventual left (LV) and right (RV) ventricular dysfunction assessed by Pulsed Wave Tissue Doppler Imaging (PWTDI) and 2D strain imaging in patients with acromegaly and no sign of clinical heart failure.Materials and Methods: 38 consecutive patients affected by acromegaly (mean age: 49± 10 years), were enrolled. A total of 20 sex- and age-matched healthy participants were recruited as control subjects. All participants underwent conventional 2-dimensional color Doppler echocardiography, pulsed wave Doppler tissue imaging at mitral annulus level, and 2D strain for analysis of longitudinal, radial and circumferential global strain. All echocardiographic examinations were performed by a commercially available echograph: GE,Vivid 7, with Echopac workstation.Results: Acromegalic patients had a greater LV mass index by body surface (101±30 g/m2) than control subjects (61±21g/ m 2., P < .0001); a greater end diastolic volume (88±22 ml) than controls (67±13), p<0.001). Ejection Fraction was comparable between the two groups. Pulsed wave Doppler tissue imaging showed a significant impairment of diastolic LV and RV longitudinal function (Em/Am ratio of mitral and tricuspid (Et/At) annulus level) and increased both LV diastolic filling pressure (Em/em': 10±3 vs 6.3±1; p<0.002) and RV Et/et'(5.8±1 vs 4.1±0.8; p<0.02). 2D Strain rate diastolic parameters showed in acromegalic patients a significant impairment of LV early (p<.0001) and late diastolic phase (p<.001), both for septum and lateral wall.Conclusion:This preliminary study demonstrates that acromegalic patients exhibit global myocardial structural and functional alterations possibly related to increased GH secretion. The main findings of this study was the detection of left and right ventricular diastolic dysfunction as evidentiated by the alteration of LV and RV E/A and E/e' ratios and of diastolic 2D strain rate parameters. These subclinical findings could be useful to select those patients who could develop an overt heart failure.