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Cardiac Status after Childhood Growth Hormone Treatment of Turner Syndrome

Department of Pediatrics, Divisions of Cardiology (J.v.d.B., L.v.O.-G., W.A.H.) and Endocrinology (E.M.N.B., S.M.P.F.d.M.K.-S.), Erasmus Medical Center, Sophia Children’s Hospital, 3015 GJ Rotterdam, The Netherlands; and Departments of Radiology (J.v.d.B., P.A.W., P.M.T.P., W.A.H.) and Epidemiology and Biostatistics (W.C.J.H.), Erasmus Medical Center, 3015 GE Rotterdam, The Netherlands

Address all correspondence and requests for reprints to: W. A. Helbing, Department of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Sp-429, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. E-mail: w.a.helbing{at}erasmusmc.nl.

Context: In Turner syndrome (TS), GH treatment is well established. Data on cardiac status after discontinuation of treatment are scarce. This study aimed to assess biventricular size and function in TS at least 6 months after discontinuation of GH treatment.

Methods: TS patients and healthy women prospectively underwent cardiac magnetic resonance imaging. Ventricular two-dimensional tomographic cine data were acquired to obtain biventricular volume, mass, and ejection fraction. Atrioventricular valve flow measurements were performed using a two-dimensional flow-sensitized sequence. Flow velocity curves were calculated and indices of biventricular diastolic filling were derived.

Results: Thirty-one patients [mean (SD) age 20 (2) yr, body surface area 1.75 (0.15) m², 5 (2) yr after GH discontinuation] and 23 normal control women [age 21 (2) yr, body surface area 1.80 (0.13) m²] were included. Compared with controls, patients had smaller mean end-diastolic volumes [right ventricle (RV), 84 (11) ml/m² vs. 79 (10), P = 0.02; left ventricle (LV), 81 (10) vs. 72 (9), P < 0.001], end-systolic volumes [RV 38 (7) ml/m² vs. 36 (6), P = 0.04; LV 34 (5) vs. 29 (4), P < 0.001], and stroke volumes [RV 46 (6) ml/m² vs. 43 (6), P = 0.03; LV, 47 (7) vs. 44 (4), P = 0.02]. Patients had a higher mean heart rate [79 (13) beats/min vs. 71 (10), P < 0.05]. Biventricular ejection fraction, mass, cardiac output, and diastolic filling pattern were comparable.

Conclusion: After discontinuation of GH treatment TS patients showed no myocardial hypertrophy and well-preserved biventricular function. Ventricular volumes were smaller in Turner patients, compared with controls, whereas mean heart rate was higher. These last observations may be part of the natural development in TS and not linked to GH treatment, which at this point we consider safe.