(Circulation. 1999;99:18-21.)
© 1999 American Heart Association, Inc.
Brief Rapid Communications |
Recombinant Growth Hormone Therapy in Patients With Ischemic Cardiomyopathy
Effects on Hemodynamics, Left Ventricular Function, and Cardiopulmonary Exercise Capacity
From the Department of Medicine II, Johannes Gutenberg-University, Mainz, Germany, and the Heart Center, Leipzig, Germany (R.Z.).
Correspondence to Harald Darius, MD, Department of Medicine II, Johannes Gutenberg-University, Langenbeckstraße 1, 55101 Mainz, Germany. E-mail darius{at}2-med.klinik.uni-mainz.de
Background—We studied the effects of recombinant growth hormone (rhGH) on exercise capacity and cardiac function in patients with ischemic cardiomyopathy.
Methods and Results—Seven patients (aged 55±9 years) with
mild to moderate congestive heart failure (ejection fraction 31±4%)
who were on standard therapy were included. The patients were studied
at baseline, after 3 months of rhGH treatment, and 3 months after rhGH
discontinuation. Cardiac function was assessed by exercise capacity,
right heart catheterization at rest and after
submaximal exercise, MRI, echocardiography, and
Holter monitoring. When administered at a dose of 2 IU/d, rhGH doubled
the serum concentration of insulin-like growth factor-I. rhGH improved
clinical symptoms and exercise capacity significantly (New York Heart
Association class 2.4±0.5 initially versus 1.4±0.5 at 3 months
[mean±SD], P<0.05;
O2max 13.6±3.8 versus 17.4±5.4 mL
· kg-1 · min-1,
P<0.05). Additionally, pulmonary capillary
wedge pressures at rest and after submaximal exercise were
reduced significantly. Cardiac output increased, particularly at rest
(5.0±1.1 versus 5.8±1.3 L/min; P<0.05). Posterior
wall thickness was increased (1.08±0.1 versus 1.24±0.3 cm;
P<0.05), and the end-diastolic and
end-systolic volume indexes decreased significantly after rhGH
treatment. There was no significant increase in left
ventricular ejection fraction. The improvements were
partially reversed 3 months after rhGH discontinuation.
Conclusions—The administration of rhGH for 3 months in patients with ischemic cardiomyopathy results in significant improvement in hemodynamics and clinical function. The attenuation of left ventricular remodeling persisted 3 months after discontinuation of treatment.
Key Words: growth substances • cardiomyopathy • cardiac output
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