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Objective: Left ventricular (LV) hypertrophy is the main finding of patients with active acromegaly at cardiac magnetic resonance (CMR). The aim of the study was to evaluate heart changes in acromegalic patients treated with somatostatin analogues (SMSA) using CMR. Design and patients: This was a prospective study. Fourteen consecutive patients (8 women, mean age 46±10 yr) with untreated active acromegaly were submitted to CMR and 2D-color Doppler echocardiography before and after a 6-month SMSA course. Measurements: LV volume, mass (LVM) and wall thickness. Results: CMR: Mean LVM and LVM index (i) decreased from 151±17 g and 77±9 g/m2, to 144±24 g and 70±12 g/m2, respectively (p=0.047 and p<0.0001, respectively); LV hypertrophy reverted in 6 out of 10 patients (p=0.016). Systolic function, evaluated by measuring LV ejection fraction remained normal in all patients (67±11%). There was not a correlation between changes in LVMi and changes in serum IGF-I concentrations. However, patients with controlled disease had higher reduction of LVMi than those with uncontrolled acromegaly (ΔLV-Mi, −8.2±4.2 vs4.0±5.3 p<0.05). 2D-echocardiography: Mean LVMi decreased from 110±24 g/m2to 100±20 g/m2(p=0.026); hypertrophy, revealed in 5 patients (36%) at baseline, reversed in 2 patients (p=0.500) after SMSA; abnormal diastolic function [evaluated by isovolumic relaxation time or early (E) to late of atrial (A) peak velocities ratio] found in 4 patients (29%) at the study entry, improved in a patient. Systolic function remained within the normal range in all patients during the study period. Conclusions: CMR detects changes in LVMi in most patients with acromegaly treated with SMSA, which are more evident if the disease is controlled.