Table 2.

Possible screening methods for each of the potential cardiovascular comorbidities encountered in patients with acromegaly, describing their main pros and cons.

	Advantage	Disadvantage
Routine measurement of blood pressure during the programmed out-patient visit (“office measurement”).	Simple, non-invasive, short duration. May be collated with ambulatory blood pressure monitoring	May overestimate the prevalence of hypertension (16).
Electrocardiography (could be the one prescribe as part of the preoperative study) Assessment of QT intervals (77–80) Registration of late potentials. Further 24 h monitoring if abnormal initial punctual screening.	Identifies patients with higher risk of rhythm disorders (50, 52)	Prognostic value in the specific setting of acromegaly has not been fully evaluated
Echocardiogram (70)	Non-invasive. High resolution for ventricular anatomy and function. Useful to assess the severity and extent of acromegalic cardiomyopathy (8, 68). Moderate cost. Good reproducibility.	Calculation of the left ventricle mass uses a cubing formula, so small errors may be amplified and left ventricle mass may be over or underestimated (77).
Echocardiogram with pulse issue Doppler	At early stages may identify subclinical biventricular impairment of systolic function (75).	Same issues as for echocardiogram.
Radionuclide angiography	Non-invasive assessment of rapid diastolic filling. Evaluates the integrity of patients' cardiac performance.	Requires injection of radionuclide into vein. Cost.
Gadolinium-enhanced magnetic resonance imaging (MRI)	Gold standard. Higher accuracy and reproducibility and lower variability than echocardiography (71, 72). Myocardial transverse relaxation time (T2) allows a non-invasive assessment for detecting myocardial edema, and thus the direct action of GH and IGF-1 on the heart. Serves to evaluate the efficacy of acromegaly treatment regarding cardiomyopathy (35).	Less available. Cost. Inconsistent cost-effectiveness (31, 40)