Growth Parameters and Endocrine Function in Relation to Echocardiographic Parameters in Children with Ventricular Septal Defect without Heart Failure

Abstract

To determine the effect of ventricular function, size of ventricular septal defect (VSD), and endocrine function on linear growth in children with VSD, we studied 88 children with VSD over a period of 1 year. Growth was assessed by determining the height standard deviation scores (HtSDS) and growth velocity (GV) every 4 months. Two hundred age-matched normal children served as controls for the growth data. Endocrine evaluation was performed in 30 randomly selected children with VSD, and 20 age-matched children with constitutional delay of growth (CSS). Growth hormone (GH) response to clonidine provocation was evaluated and circulating free thyroxine (FT4) and insulin-like growth factor-I (IGF-I) concentrations measured. Echocardiographic evaluation of the different cardiac parameters including shunt size and shunt fraction (Qp/Qs) was performed using a colour-coded echodoppler. The HtSDS, body mass index (BMI), and mid-arm circumference (MAC) of children with VSD were significantly decreased compared to those for the normal control group. The dietary intake evaluated by the recall method, appeared to be adequate in the majority of these children (83/88). IGF-I concentrations were reduced in children with VSD (87.5 +/- 29 ng/ml) versus normal age-matched children (169 +/- 42 ng/ml). Basal and clonidine-stimulated GH concentrations were significantly higher in children with VSD (4.6 +/- 2.1 microg/l and 28.8 +/- 7.9 microg/l respectively) versus controls (17.8 +/- 4.2 microg/l). In these patients (n = 88) the HtSDS was correlated negatively with the size of the shunt (r = -0.793, p < 0.001), shunt fraction (Qp/Qs) (r = -0.76, p < 0.001), pulmonary mean gradient (r = -0.4, p = 0.006), and pulmonary maximum velocity (r = -0.32, p = 0.02). Growth velocity (GV) was correlated negatively with pulmonary maximum gradient (r = -0.3, p = 0.02), pulmonary maximum velocity (r = -0.37, p = 0.007), and pulmonary stroke volume (Qp) (r = -0.345, p = 0.01). The BMI and IGF-I concentrations were correlated significantly with the size of the shunt (r = -0.453, p < 0.01), Qp/Qs (r = -0.432, p < 0.01), HtSDS (r = 0.565, p < 0.01), and BMI (r = 0.435, p < 0.01). It appears that in patients with VSD, the size of the left-to-right shunt and the abnormal hemodynamics in the pulmonary circulation are important factors in the etiology of impaired growth. It is suggested that the hypermetabolic status of these patients compromise nutrition and this decreases IGF-I synthesis with subsequent slowing of linear growth and weight gain.

The Effect of Transcatheter Ventricular Septal Defect Closure on Children's Appetite, Hormones and Growth

“…When we compare the other laboratory parameters; leptin, IGF-1 and IGFBP-3 levels were significantly low in the patient group at initial compared to control. Similar to our results, Soliman et al (28) found that basal IGF-1 levels in patients with VSD were statistically significantly lower than in the control. In the study conducted by Surmeli-Onay et al (29), IGF-1 and IGFBP-3 levels were found to be lower in the in patients with preoperative CHD group compared to the control.…”

Ghrelin protects the myocardium with hypoxia/reoxygenation treatment through upregulating the expression of growth hormone, growth hormone secretagogue receptor and insulin-like growth factor-1, and promoting the phosphorylation of protein kinase�B

“…Certain studies have demonstrated that the main role of ghrelin in cardiac myocytes is to promote the expression of non-functional GHSR ( 31 ). Another report also indicated that, in addition to GHSR, ghrelin may have other unknown receptors in the cardiac repair system ( 32 ). According to the results of RT-PCR and western blot analysis, ghrelin promoted the expression of GHSR and GH, and repaired hypoxic cardiac myocytes.…”

Congenital heart disease and the prevalence of underweight and obesity from age 1 to 15 years: data on a nationwide sample of children

“… 4 Studies have reported associations of impaired haemodynamic status with impaired growth and with lower body mass index (BMI). 5 6 On the other hand, as the incidence of overweight and obesity increases in the general population, 7 a similar and potentially more pronounced trend might be expected of the CHD population. This may be exacerbated in the CHD population because of potential exercise intolerance and recommendations of activity restriction.…”