BACKGROUND: Acromegalic heart disease (AHD) is a common complication of acromegaly; however, evidence specifically focused on women in Latin America remains limited. OBJECTIVE: To characterize cardiomyopathy in women with acromegaly and identify clinical factors associated with its presence. METHODS: We conducted a secondary analysis of the multicenter RAPACO-Heart registry in Colombia. Women aged ≥18 years with confirmed acromegaly and available echocardiographic evaluation were included. Clinical, anthropometric, biochemical, and echocardiographic data were analyzed. Cardiomyopathy was defined by echocardiographic abnormalities consistent with AHD. Multivariable logistic regression was used to identify factors independently associated with cardiomyopathy. RESULTS: A total of 116 women were included, of whom 34 (29.3%) had cardiomyopathy. Women with cardiomyopathy were older and had longer disease duration. Hypertension, arrhythmias, and carpal tunnel syndrome were more frequent in this group. In multivariable analysis, age (adjusted OR 1.07 per year; 95% CI 1.03-1.12; p = 0.001), hypertension (adjusted OR 3.9; 95% CI 1.4-11.1; p = 0.009), arrhythmias (adjusted OR 2.8; 95% CI 1.1-7.4; p = 0.03), and carpal tunnel syndrome (adjusted OR 2.6; 95% CI 1.1-6.5; p = 0.04) were independently associated with cardiomyopathy. CONCLUSIONS: Cardiomyopathy was present in nearly one-third of women with acromegaly and was associated with older age and a higher burden of cardiovascular comorbidities. These findings highlight an underrecognized cardiovascular burden and support targeted cardiovascular assessment in this population.