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Cardiac Effects of Growth Hormone Treatment in Chronic Heart Failure: A Meta-Analysis

Service de Pharmacologie Clinique (I.M.-M., P.M.), Fédération de Cardiologie (P.L.C., L.H.), Centre d’Investigation Clinique (O.M., P.L.C.), Unité de Recherche Clinique (P.M.), Assistance Publique-Hôpitaux de Paris, Université Paris XII, Faculté de Médecine, Centre Hospitalier Universitaire (CHU) Henri Mondor, 94010 Créteil, France; Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 421 (P.M.), 94000 Créteil, France; INSERM Unité 660 (P.L.C., L.H.), 94000 Créteil, France; Service d’Endocrinologie et des Maladies de la Reproduction (P.C.), Assistance Publique-Hôpitaux de Paris, and INSERM Unité 693, CHU Bicêtre, and Faculté de Médecine Paris-Sud, Université Paris XI, 94270 Le Kremlin-Bicêtre, France

Address all correspondence and requests for reprints to: Dr. P. Maison, Service de Pharmacologie Clinique, Centre Hospitalier Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, F-94010 Créteil, France. E-mail: patrick.maison{at}hmn.ap-hop-paris.fr.

Context: Experimental studies suggest that GH treatment may improve cardiovascular parameters in chronic heart failure (CHF). However, clinical trials involved small numbers of patients and did not allow a conclusion to be drawn on the effect of this treatment in humans.

Objective: We systematically reviewed and analyzed all randomized controlled trials and open studies of sustained GH treatment in CHF.

Study Selection: Twelve trials were identified in three databases. We conducted a combined analysis of GH effects on cardiovascular parameters using the overall effect size to evaluate significance and computing the weighted mean differences with and without treatment to assess effect size.

Data Synthesis: GH treatment significantly modified morphological cardiovascular parameters [interventricular septum thickness, +0.55 (SD, 0.43) mm (P < 0.001); posterior wall thickness, +1.01 (0.44) mm (P < 0.01); left ventricle (LV) end-diastolic diameter, –2.02 (1.22) mm (P < 0.01); and LV end-systolic diameter, –5.30 (2.33) mm (P < 0.05)]; LV and systemic hemodynamics [LV end-systolic wall stress, –38.9 (13.3) dynes/cm² (P < 0.001); LV ejection fraction, +5.10 (1.74)% (P < 0.05); and systemic vascular resistance, +195.0 (204.5) dyn·sec^–1·cm^–5 (P < 0.01)]; and functional parameters [New York Heart Association class, –0.97 (0.23) (P < 0.01); exercise duration, +103.7 (37.6) sec (P < 0.001); and maximal oxygen uptake, +2.48 (1.76) ml/kg·min (P < 0.01)]. Subgroup analysis and meta-regression showed significant relationships between the IGF-I response and GH treatment effects.

Conclusion: Our meta-analysis suggests that GH treatment improves several relevant cardiovascular parameters in patients with CHF. However, these results must be confirmed by a large randomized placebo-controlled trial on hemodynamic, morphological, and functional parameters during long-term high-dose GH treatment of patients with CHF.

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