Cardiac resynchronization therapy improves heart failure in one patient with acromegaly-induced cardiomyopathy: a case report.

BACKGROUND: Congestive heart failure is rarely observed in patients with acromegaly. Excessive growth hormone secretion and elevation of insulin-like growth factor 1 contribute to pathological changes in myocyte growth and structure, cardiac contractility, vascular function, and in later stage may progress to cardiac dysfunction. Early recognition of the condition is paramount, though the insidious progression of the disease commonly results in late diagnosis. Current standard regimens of pharmacological therapy, surgical treatment, radiotherapy are designed to normalize serum levels of both insulin-like growth factor 1 and growth hormone. In patients with late-stage heart failure due to acromegalic cardiomyopathy, cardiac resynchronization therapy might be a desirable treatment to help cardiac synchronization, improve symptoms, and eventually reduce hospital admissions together with mortality rates. CASE PRESENTATION: We describe a case of a 49-year-old man with a history of acromegaly who presented to our hospital with a diagnosis of decompensated systolic heart failure. Serial electrocardiograms showed wide (160-200 ms) QRS duration with left bundle branch block. Echocardiography showed severe left ventricular dysfunction that simultaneously achieved a left ventricular ejection fraction of 16%. Surgical indication was rarely assessed by neurosurgeons. Given that the stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects, cardiac resynchronization therapy was performed. Owing to biventricular synchronization and holding back reverse remodeling, the patient's symptoms were successfully alleviated, and he was discharged from the hospital. CONCLUSIONS: Congestive heart failure is a rare complication in acromegaly-induced cardiomyopathy (occurs in only 3% of patients). Early diagnosis and treatment with curative drugs more than cardiovascular implantable electronic devices might lead to better surgical outcomes in this group of patients.

[Expression of peroxisome proliferator-activated receptor alpha and beta in peripheral blood mononuclear cells of non-vavular hypertensive atrial fibrillation patients].

OBJECTIVE: To determine the mRNA expressions of PPARalpha and PPARbeta in peripheral blood mononuclear cells of non-vavular hypertensive atrial fibrillation (AF) patients and elucidate its possible role in the pathogenesis of AF. METHODS: Peripheral blood samples were collected from 103 patients with hypertensive AF (persistent AF: 55, paroxysmal AF: 48) and 50 age-adjusted hypertension patients without AF. The mRNA expressions of PPARalpha, PPARbeta, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in monocytes were detected by using a Real time polymerase chain reaction. The concentrations of high sensitive C-reactive protein (CRP) and interleukin-1 (IL-1) were measured by immunoenzymetric method. RESULTS: The PPARalpha mRNA expression level was persistently decreased in hypertensive non-AF group, paroxysmal AF group, and persistent AF group (1.34 +/- 0.17, 1.09 +/- 0.23, 0.85 +/- 0.22), while the difference was statistically significant (P < 0.001; respectively). TNF-alpha mRNA, IL-6 mRNA,CRP and IL-1 persistently increased in hypertensive non-AF group, paroxysmal AF group, persistent AF group, also the difference was statistically significant (P < 0. 001; respectively). The difference of PPARbeta mRNA was not statistically significant between non-AF group, paroxysmal AF group and persistent AF group. Left atrial diameter (LAD) was in positive correlation with CRP, IL-1, IL-6 mRNA and TNF-alpha mRNA (P < 0.05). PPARalpha mRNA level was in negative correlation with CRP, IL-1, IL-6 mRNA and TNF-alpha mRNA, the correlation coefficient was -0.519, -0.532, -0.491 and -0.528, respectively (P < 0.05). CONCLUSION: In hypertensive patients with AF, increased inflammatory cytokines were associated with atrial remodeling and lead to the development of atrial fibrillation; PPARalpha was negatively correlated with these inflammatory cytokines and may play a vital role in the process of atrial fibrillation development.

[Changes in the prevalence of obesity and abdominal obesity in middle-aged Chengdu residents during 1992 and 2007].

OBJECTIVE: To analyze the changes in the prevalence of obesity and abdominal obesity in the middle-aged Chengdu residents during 1992 and 2007. METHODS: In 1992, a cohort of 1365 Chengdu residents were selected using a combination of nonrandom cluster sampling and intra-cluster random sampling stratified by age and gender for cardiovascular disease risk factor surveys. In 2007, 1061 of the selected residents completed a second survey. We analyzed the changes in the prevalence of obesity and abdominal obesity in the middle-aged residents using BMI and waist circumference as indicators. RESULTS: From 1992 to 2007, the BMI, waist circumference, prevalence of obesity and abdominal obesity of this cohort of respondents increased significantly (P < 0.05). The 2007 survey found significant higher BMI, waist circumference, and prevalence of obesity and abdominal obesity in the residents of 50-64 years old than those with the same age in 1992 (P < 0.05). The female respondents had consistently greater standardized prevalence of obesity and abdominal obesity than their male counterparts except for the abdominal obesity in the 2007 survey. CONCLUSION: Both prevalence of obesity and abdominal obesity are increasing in Chengdu residents, even after adjustment of age.

[Association of PPARgamma2 Pro12Ala polymorphism and cognitive dysfunction in hypertension patients].

OBJECTIVE: To study the relationship between PPARgamma2 Pro12Ala polymorphism and cognitive function in patients with primary hypertension. METHODS: This study enrolled 502 hypertensive patients of Chinese Han population from Jan 2008 to Feb 2009 in West China Hospital of Sichuan University. We collected the general data and applied the mini mental state examination (MMSE) to test the cognitive function and computed score. Total cholesterol (TC), triglyeride (TG), fasting plasma glucose (FPG) and postprandial blood sugar (PPBS), fasting insulin (FINS) and postprandial plasma insulin (PINS) were measured. PCR-RELP method was used to analysis the PPARgamma2 Pro12Ala gene polymorphism. RESULTS: Pro12Pro genotype was present in 88.6% of the patients and Prol2Ala genotype was present in 11.4% of the population. Allele frequencies were 94.3% for Pro allele and 5.7% for Ala allele. In cognitive normal group, the frequencies of PP and PA genotype were 328 (87.2%) and 48 (12.8%), while the frequencies of PP and PA genotypes in the cognitive dysfunction group were 126 (92.9%), 9 (7.1%) respectively. Analyzed by chi2 test, both the genotype frequency and the allele frequency of PPARy2 Pro12Ala polymorphism did not display statistical variability between the cognitive normal group and the cognitive dysfunction group, even eliminating the influence of age and sexuality. CONCLUSION: Pro12Ala polymorphism in PPARgamma2 with primary hypertension may not associate with cognitive impairment.