Characterisation of myocardial structure and function in adult-onset growth hormone deficiency using cardiac magnetic resonance

Abstract

Growth hormone (GH) can profoundly influence cardiac function. While GH excess causes well-defined cardiac pathology, fewer data are available regarding the more subtle cardiac changes seen in GH deficiency (GHD). This preliminary study uses cardiac magnetic resonance imaging (CMR) to assess myocardial structure and function in GHD. Ten adult-onset GHD patients underwent CMR, before and after 6 and 12 months of GH replacement. They were compared to 10 age-matched healthy controls and sex-matched healthy controls. Left ventricular (LV) mass index (LVMi) increased with 1 year of GH replacement (53.8 vs. 57.0 vs. 57.3 g/m2, analysis of variance p = 0.0229). Compared to controls, patients showed a trend towards reduced LVMi at baseline (51.4 vs. 60.0 g/m2, p = 0.0615); this difference was lost by 1 year of GH treatment (57.3 vs. 59.9 g/m2, p = 0.666). Significantly reduced aortic area was observed in GHD (13.2 vs. 19.0 cm2/m2, p = 0.001). This did not change with GH treatment. There were no differences in other LV parameters including end-diastolic volume index (EDVi), end-systolic volume index, stroke volume index (SVi), cardiac index and ejection fraction. There was a trend towards reduced baseline right ventricular (RV)SVi (44.1 vs. 49.1 ml/m2, p = 0.0793) and increased RVEDVi over 1 year (70.3 vs. 74.3 vs. 73.8 ml/m2, p = 0.062). Two patients demonstrated interstitial expansion, for example with fibrosis, and three myocardial ischaemia as assessed by late gadolinium enhancement and stress perfusion. The increased sensitivity of CMR to subtle cardiac changes demonstrates that adult-onset GHD patients have reduced aortic area and LVMi increases after 1 year of GH treatment. These early data should be studied in larger studies in the future.

Late cardiovascular morbidity and mortality following pediatric allogeneic hematopoietic cell transplantation

“…26 Deficiency of growth hormone and/or IGF-1 have been linked to myocardial hypokinesis, altered cardiac growth, and abnormal response to exercise. [26][27][28][29] A single center study compared the cardiac structure and function of 13 survivors of childhood cancer therapy who received cranial radiation therapy without systemic chemotherapy to their healthy siblings. 26 They found that the childhood cancer survivors who received cranial radiation therapy had lower IGF-1 levels, smaller cardiac volumes and decreased left ventricular systolic and diastolic function compared to their siblings.…”

Retrospective Analysis of Endocrine Dysfunctions in a Population of Adult Polytransfused Patients: Correlation of GH-IGF1 Axis Alteration with Cardiac Performance

“…It is well known that the GH/IGF-1 axis regulates cardiac growth, stimulates myocardial contractility, and influences the vascular system [ 20 , 21 ]. Patients with either childhood- or adulthood-onset GHD develop cardiovascular abnormalities such as reduced cardiac mass, diastolic filling and left ventricular response at peak exercise, increased intima-media thickness, and endothelial dysfunction, reversed, at least partially, by GH replacement therapy [ 22 – 25 ].…”

Growth Hormone Deficiency: Is It Just a Problem of Growth Impairment? Part I

“…Therefore, and given the positive effects of GH on the heart, it is likely that GH treatment may be useful in patients with heart failure, even if they are not GHD. Many recent studies support such a possibility, and the treatment with GH has been proposed and carried out with very good results in untreated GHD children and adults with heart failure and also in patients suffering this affectation even though they are not GHD [109][110][111][112][113][114][115][116][117], although there are studies suggesting that this GH therapy only provides positive results in GHD patients [118].…”