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This version published online on October 24, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-1313
A more recent version of this article appeared on January 1, 2007
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Submitted on June 20, 2006
Accepted on October 17, 2006

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

Philippe LeCorvosier, Luc Hittinger, Philippe Chanson, Olivier Montagne, Isabelle Macquin-Mavier, and Patrick Maison*

Service de Pharmacologie Clinique (IMM, PM), Fédération de Cardiologie (PLC, LH), Centre d'Investigation Clinique (OM, PLC), Unité de Recherche Clinique (PM), Assistance Publique-Hôpitaux de Paris, Université Paris XII, Faculté de médecine, CHU Henri Mondor, Créteil; INSERM U421 (PM), Créteil; INSERM U660 (PLC, LH), Créteil; Service d'Endocrinologie et des Maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, and INSERM U693, CHU Bicêtre, and Faculté de Médecine Paris-Sud, Université Paris-XI (PC), Le Kremlin-Bicêtre; all in France

* To whom correspondence should be addressed. E-mail: patrick.maison{at}hmn.ap-hop-paris.fr.

CONTEXT: Experimental studies suggest that growth hormone (GH) treatment may improve cardiovascular parameters in chronic heart failure (CHF). However, clinical trials involved small numbers of patients and did not allow to conclude 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 [NYHA 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)]. Sub-group 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.
Key words: heart • growth hormone • meta-analysis




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eLetters:

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E-Letter to the Editor: Effects of Growth Hormone Treatment in Chronic Heart Failure
Serafino Fazio, et al.
JCEM Online, 14 Dec 2006 [Full text]

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