Left ventricular function in young adults with childhood and adulthood onset growth hormone deficiency

Longobardi, Salvatore; Cuocolo, Alberto; Merola, B; Rella, Francesca Di; Colao, Annamaria; Nicolai, Emanuele; Cardei, Stefania; Salvatore, Marco; Lombardi, Gaetano

doi:10.1046/j.1365-2265.1998.00281.x

Cited by 103 publications

(69 citation statements)

References 37 publications

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“…385 Although some studies suggest that cardiac dysfunction might be more severe in GH-deficient patients with childhood-onset disease than in patients with adult-onset disease caused by the lack of GH/ IGF-1 during growth and development of the heart, 391 this has not been seen consistently across other studies. 409 Short-term placebo-controlled studies have shown that GH replacement therapy in adult GH-deficient patients has an anabolic effect on cardiac structure, which results in an improvement in both diastolic and systolic function. 391,410,411 A few open-label studies have determined the long-term effects of GH replacement therapy on cardiac function.…”

Section: 394mentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

624

663

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CLINICAL STATEMENTS AND GUIDELINEST he intent of this American Heart Association (AHA) scientific statement is to summarize our current understanding of dilated cardiomyopathies. There is special emphasis on recent developments in diagnostic approaches and therapies for specific cardiomyopathies. Recommendations in this document are based on published studies, published practice guidelines from the American College of Cardiology (ACC)/AHA 1 and other organizations, 2,3 and the multidisciplinary expertise of the writing group. Existing evidence in epidemiology, classification, diagnosis, and management of specific cardiomyopathies is usually derived from nonrandomized observational studies, registries, case reports, or expert opinion based on clinical experience, not large-scale randomized clinical trials or systematic reviews. Therefore, in this document, rather than using the standard ACC/AHA classification schema of recommendations and level of evidence, 4 we have included key management strategies at the end of each section and categorized our recommendations according to the level of consensus. Although the format of our recommendations might resemble the ACC/AHA classification of recommendations used in the ACC/AHA practice guidelines, because of the preponderance of expert opinion or level of evidence C evidence in our document, we elected to use different terminology to provide a distinction from the practice guidelines, in which stronger levels and quality of evidence with randomized clinical trials or meta-analyses are usually present. 4 The levels of evidence follow the AHA and ACC methods of classifying the level of certainty of the treatment effect. 4 DEfINITIoN of DILATED CArDIoMyopAThyThe term dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease. 5 In clinical practice, the pathogenesis of heart failure (HF) has often been placed into 2 categories: ischemic and nonischemic cardiomyopathy. The term nonischemic cardiomyopathy has been interchangeably used with DCM. Although this approach might be practical, it fails to recognize that nonischemic cardiomyopathy can include cardiomyopathies caused by volume or pressure overload (such as hypertension or valvular heart disease) that are not conventionally accepted under the definition of DCM. 1,5 Again, in general practice and clinical research trials, the term ischemic cardiomyopathy is defined as cardiomyopathy caused by ischemic heart disease. Current use of ischemic cardiomyopathy terminology implies ventricular dilation and depressed myocardial contractility caused by ischemia or infarction. CLASSIfICATIoN of CArDIoMyopAThIESThe first classification on this topic categorized cardiomyopathies as heart muscle diseases with dilated (DCM), hypertrophic, restrictive, arrhythmogenic right ventricular (ARVC), or nonclassifiable cardiomyopathy in 1980. 5 Subse...

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Section: 394mentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

624

663

View full text Add to dashboard Cite

show abstract

“…Last, the study populations are heterogeneous (childhood-onset or adulthood-onset GHD, age differences, and so forth), and this probably attenuates the observed effects of GH on systolic function, which is more strongly impaired in younger patients. 9,10,32,36,37 Diastolic function improved in a few published studies, 17,20 but the improvement was not significant in our meta-analysis, possibly owing to the small number of studies assessing the relevant parameters.…”

Section: Discussionmentioning

confidence: 66%

Cardiac Effects of Growth Hormone in Adults With Growth Hormone Deficiency

2003

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Background-Growth hormone (GH) treatment may improve morphological and functional cardiac parameters in adults with GH deficiency (GHD). However, clinical trials reported to date involved few patients and yielded variable effects. Methods and Results-We systematically reviewed blinded, placebo-controlled, randomized clinical trials of GH treatment in adults with GHD and open studies in patients with GHD before and after GH treatment, evaluating the effects of GH on cardiac parameters assessed by echocardiography. Sixteen trials (9 blinded and 7 open), involving a total of 468 patients, were identified in 3 bibliographic databases. GH dosage, duration of treatment, and study populations varied among the studies. We conducted a combined analysis of effects on left ventricular mass (LVM), interventricular septum thickness (IVS), left ventricular posterior wall (LVPW), left ventricular end-systolic (LVESD) and diastolic (LVEDD) diameters, stroke volume, E/A ratio, isovolumic relaxation time (IRT), and fractional shortening. Overall effect size was used to evaluate significance, and weighted mean difference between GH and control was given to appreciate size of the effect. GH treatment was associated with a significant increase in LVM: ϩ10.

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“…These differences were not confirmed in other studies or in GHD patients with adult-onset disease (19,20). Using equilibrium radionuclide angiography, we first reported LV systolic dysfunction at rest and at peak physical exercise in a group of GHD patients of less than 40 years of age, without any difference between childhoodand adulthood-onset GHD (21). These results were subsequently confirmed in another cohort of adult GHD patients in whom we did not find any difference between young patients (aged , 35 years) and middle-aged patients (36 -60 years) (22).…”

Section: Cardiac Involvement In Gh Deficiencymentioning

confidence: 69%

The heart: an end-organ of GH action

Colao

Vitale

Pivonello

et al. 2004

European Journal of Endocrinology

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Several experimental and clinical studies have indicate that the heart is an end-organ of GH action. Patients with either childhood-or adulthood-onset GH deficiency (GHD) have abnormalities of cardiac structure and function, such as reduced cardiac mass, impaired diastolic filling and reduced left ventricular response at peak exercise. These cardiovascular abnormalities can be reversed, at least partially, after GH replacement therapy. On the other hand, the chronic overproduction of GH and IGF-I in acromegaly leads to the development of a specific cardiomyopathy. Concentric cardiac hypertrophy occurs in more than two-thirds of patients at diagnosis and is commonly associated with diastolic dysfunction. In later stages, impaired systolic function ending in heart failure can occur if GH/IGF-I excess is not controlled. Additionally, acromegalic cardiomyopathy is complicated by abnormalities of cardiac rhythm and cardiac valves. Successful control of acromegaly is accompanied by a decrease of the left ventricular mass and improvement of cardiac function. These beneficial effects appear earlier in young patients with short disease duration than in elderly patients. In conclusion, GH and IGF-I play a main role in the regulation of cardiac development and performance.European Journal of Endocrinology 151 S93-S101

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Left ventricular function in young adults with childhood and adulthood onset growth hormone deficiency

Cited by 103 publications

References 37 publications

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Cardiac Effects of Growth Hormone in Adults With Growth Hormone Deficiency

The heart: an end-organ of GH action

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