Biomarker signature for the response to cyclic GMP PDE5 inhibitors in acromegaly cardiomyopathy
Cardiovascular complications are one of the most prevalent in patients with acromegaly and contribute to the increase of morbidity and mortality associated with the disease. Specifically, cardiomyopathy may be frequent findings. The underlying physiopathology and evolutionary progression has not been fully elucidated, although uncontrolled and prolonged disease, age and coexistence of other cardio-vascular risk factors are significant influencing variables. Nowadays no specific therapies, targeting the main physiopathology mechanisms, exist to arrest this important complication. Our team group perform a pilot study proof-of-concept with 15 patients with acromegaly cardiomyopathy to evaluate the effect of 5 months of phosphodiesterase type 5A (PDE5A) inhibition (Tadalafil 20 mg once daily) on structural and functional cardiac alterations, measured by Cardiac Magnetic Resonance (CMR) and 2D-Echocardiography. The aim of this study is to identify a cluster of circulating cardiovascular (NT-ProBNP, TGFb, MCP1) and oxidative stress (iNOS, COX2, ROS, RANTES) markers. The changes of these markers will be analyzed together with the structural and functional cardiac parameters, analyzed by our team group, to provide an overall overview of acromegaly cardiomyopathy and detect predictive markers for treatment response.