The influence of growth hormone (GH) therapy on cardiac performance in patients with childhood onset GH deficiency

Objective: There is accumulating evidence that growth hormone (GH) plays an important role in the maintenance of normal cardiac growth and function. Abnormalities in left ventricular diastolic function and impairment of systolic function have also been reported in patients with GHD. In this study, we investigated the effects of 12 months GH replacement therapy on cardiac functional indices measured by echocardiography, the ECG stress test and SPECT imaging. Design: Sixteen patients with childhood onset GHD (age 42.3 +/- 13.1 years, 10 males) were investigated before. and after. 12 months of GH treatment at a dosage of 0.02 IU/kg/day (7 mu g/kg/day). The GH administration resulted in serum IGF-1 levels within the normal range in all the patients. The following investigations were performed initially and after 12 months: electrocardiography, systolic and diastolic blood pressure, heart rate measurement, a complete Doppler-echocardiographic examination, treadmill exercise test and Technetium-99m sestamibi single-photon emission computer tomography (SPECT) imaging at rest and after exercise. Results: Echocardiography showed improvement in left ventricular systolic function after GH treatment. End-systolic volume fell from 29.9 +/- 12.4 to 24.4 +/- 6.9 ml (p < 0.05) and the ejection fraction increased from 56.2 +/- 7.2% to 63.2 +/- 6,1% (p < 0.01). Left ventricular diameter and wall thickness did not change after GH treatment, although systolic increase in interventricular septum thickness (IVS%) and systolic increase in posterior wall thickness (PWT%) increased significantly (IVS% 52.2 +/- 31.9% vs. 67.3 +/- 30.4% and PWT% 48.7 +/- 20.2% vs. 58.0 +/- 17.7%, p < 0.01, p < 0.01, respectively). Contractile function, measured at midwall level, improved as left ventricular midwall fractional shortening (MWS) increased (16.11 +/- 6.55 vs. 23.30 +/- 5.89 %, p < 0.01) and stress-corrected MWS increased between the examinations performed before and after 12 months of GH treatment (90.97 +/- 36.66 vs. 133.10 +/- 32.84 %, p < 0.01). Diastolic function did not change, as assessed by early diastolic flow (E), diastolic flow secondary to atrial contraction (A), or the E/A ratio. The LV-mass index did not change significantly after GH treatment (78.4 +/- 22.1 vs. 81.9 +/- 21.1 g/m(2)). After 12 months of GH treatment the myocardial performance index (MPI) decreased significantly from 0.483 +/- 0.146 at baseline to 0.410 +/- 0.086 at the end of the study (p < 0.05). There was a trend towards an increase in exercise duration and capacity after GH treatment but the differences did not reach levels of statistical significance. SPECT imaging basally and after 12 months showed normal myocardial perfusion at rest and after exercise in all the patients. In conclusion, GH replacement therapy in adults with GHD demonstrated the beneficial effects on cardiac functions. (c) 2005 Elsevier Ltd. All rights reserved.