Published online before print November 17, 2003, doi: 10.1161/01.CIR.0000100720.01867.1D
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(Circulation. 2003;108:2648.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Cardiac Effects of Growth Hormone in Adults With Growth Hormone Deficiency
A Meta-Analysis
From the Department of Clinical Pharmacology and Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil and INSERM U258, Villejuif (P.M.); the Department of Endocrinology and Reproductive Diseases, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital and Faculté de Médecine Paris-Sud, University Paris-XI, Le Kremlin-Bicêtre, (P.C.), France.
Correspondence to Pr P. Chanson, Endocrinology, CHU Bicêtre, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre, Cedex, France. E-mail philippe.chanson{at}bct.ap-hop-paris.fr
Received March 13, 2003; de novo received July 17, 2003; revision received August 27, 2003; accepted August 27, 2003.
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: +10.8 (SD: 9.3) g (P=0.02); IVS: +0.28 (0.38) mm (P<0.001), LVPW: 0.98 (0.22) mm (P=0.05), LVEDD: +1.34 (1.13) mm (P<0.001), and stroke volume: +10.3 (8.7) mL (P<0.001). A trend toward a difference in fractional shortening was observed: +1.1 (1.1)% (P=0.06). Overall effect sizes were not significant for LVESD, E/A, and IRT.
Conclusions— GH treatment is associated with a significant positive effect on LVM, IVS, LVPW, LVEDD, and stroke volume, as assessed by echocardiography, in adults with GHD.
Key Words: heart failure • echocardiography • growth substances • hormones • meta-analysis
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