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Cardiac effects of growth hormone in adults with growth hormone deficiency: a meta-analysis
Patrick Maison1, Philippe Chanson
1Department of Clinical Pharmacology and Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil and INSERM U258, Villejuif, France.
Insights
Growth hormone (GH) treatment significantly improves cardiac structure and function in adults with GH deficiency (GHD). Echocardiography showed positive effects on left ventricular mass and dimensions, enhancing stroke volume.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Growth hormone (GH) deficiency (GHD) can impact cardiac health in adults.
- Previous clinical trials on GH treatment for cardiac parameters in GHD adults had limited sample sizes and variable outcomes.
- Understanding the precise effects of GH treatment on cardiac function is crucial for managing GHD.
Purpose of the Study:
- To systematically review and analyze the effects of Growth Hormone (GH) treatment on cardiac parameters in adults with GH deficiency (GHD).
- To evaluate the impact of GH therapy on echocardiographically assessed cardiac metrics, including ventricular mass, dimensions, and function.
- To synthesize findings from randomized controlled trials and open studies to provide a comprehensive overview of GH's cardiovascular effects in GHD.
Main Methods:
- Systematic review of blinded, placebo-controlled, randomized clinical trials and open studies involving GH treatment in adult GHD patients.
- Inclusion of 16 trials (9 blinded, 7 open) with a total of 468 participants.
- Combined analysis of echocardiographic parameters: 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.
Main Results:
- GH treatment significantly increased left ventricular mass (LVM) (+10.8 g, P=0.02).
- Significant increases were observed in interventricular septum thickness (IVS) (+0.28 mm, P<0.001), left ventricular posterior wall (LVPW) (+0.98 mm, P=0.05), left ventricular end-diastolic diameter (LVEDD) (+1.34 mm, P<0.001), and stroke volume (+10.3 mL, P<0.001).
- A trend towards improved fractional shortening was noted (+1.1%, P=0.06), while LVESD, E/A ratio, and IRT showed no significant changes.
Conclusions:
- Growth hormone (GH) treatment demonstrates significant positive effects on left ventricular mass (LVM), interventricular septum thickness (IVS), left ventricular posterior wall (LVPW), left ventricular end-diastolic diameter (LVEDD), and stroke volume in adults with GH deficiency (GHD).
- These findings, assessed via echocardiography, indicate improvements in cardiac morphology and function.
- The study supports the role of GH therapy in ameliorating cardiac abnormalities associated with GHD in adults.
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.
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