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Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic
Michele Arcopinto1, Andrea Salzano1, Francesco Giallauria1
1Dipartimento di Scienze Mediche Traslazionali, Federico II University, Naples, Italy.
Insights
Growth hormone deficiency (GHD) affects approximately 30% of chronic heart failure (CHF) patients, leading to impaired functional capacity and increased mortality. This study highlights GHD as a significant factor in CHF progression and outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Growing evidence links growth hormone (GH) deficiency (GHD) to cardiovascular dysfunction.
- Prevalence and impact of GHD in chronic heart failure (CHF) patients remain understudied.
- This study investigates GHD prevalence and correlates in a large CHF cohort.
Purpose of the Study:
- To determine the prevalence of GHD in patients with mild-to-moderate CHF.
- To explore the clinical and functional characteristics associated with GHD in CHF.
- To assess the prognostic implications of GHD in CHF patients.
Main Methods:
- 130 CHF patients underwent GH provocative testing (GHRH+arginine).
- Patients were classified into GHD (n=88) and GH-sufficiency (GHS, n=42) groups.
- Comprehensive cardiovascular assessments, including echocardiography and exercise testing, were performed.
Main Results:
- GHD was present in approximately 30% of CHF patients.
- GHD patients exhibited impaired left ventricular volumes, increased wall stress, and reduced right ventricular performance compared to GHS patients.
- GHD was associated with lower peak oxygen consumption (VO2), reduced ventilatory efficiency (VE/VCO2 slope), elevated NT-proBNP, and significantly higher all-cause mortality (40% vs. 25%).
Conclusions:
- GH deficiency identifies a distinct subgroup of CHF patients.
- This subgroup is characterized by diminished functional capacity, adverse left ventricular remodeling, and elevated NT-proBNP levels.
- GHD is an independent predictor of increased all-cause mortality in CHF patients.
Background:
Although mounting evidence supports the concept that growth hormone (GH) deficiency (GHD) affects cardiovascular function, no study has systematically investigated its prevalence and role in a large cohort of chronic heart failure (CHF) patients. Aim of this study is to assess the prevalence of GHD in mild-to-moderate CHF and to explore clinical and functional correlates of GHD.
Methods:
One-hundred thirty CHF patients underwent GH provocative test with GHRH+arginine and accordingly categorized into GH-deficiency (GHD, n = 88, age = 61.6±1.1 years, 68% men) and GH-sufficiency (GHS, n = 42, age = 63.6±1.5 years, 81% men) cohorts. Both groups received comprehensive cardiovascular examination and underwent Doppler echocardiography, cardiopulmonary exercise testing, and biochemical and hormonal assay.
Results:
GHD was detected in roughly 30% of CHF patients. Compared to GHD, GHS patients showed smaller end-diastolic and end-systolic LV volumes (-28%, p = .008 and -24%, p = .015, respectively), lower LV end-systolic wall stress (-21%, p = .03), higher RV performance (+18% in RV area change, p = .03), lower estimated systolic pulmonary artery pressure (-11%, p = .04), higher peak VO2 (+20%, p = .001) and increased ventilatory efficiency (-12% in VE/VCO2 slope, p = .002). After adjusting for clinical covariates (age, gender, and tertiles of LV ejection fraction, IGF-1, peak VO2, VE/VCO2 slope, and NT-proBNP), logistic multivariate analysis showed that peak VO2 (β = -1.92, SE = 1.67, p = .03), VE/VCO2 slope (β = 2.23, SE = 1.20, p = .02) and NT-proBNP (β = 2.48, SE = 1.02, p = .016), were significantly associated with GHD status. Finally, compared to GHS, GHD cohort showed higher all-cause mortality at median follow-up of 3.5 years (40% vs. 25%, p < .001, respectively), independent of age, sex, NT-proBNP, peak VO2 and LVEF.
Conclusions:
GH deficiency identifies a subgroup of CHF patients characterized by impaired functional capacity, LV remodeling and elevated NT-proBNP levels. GHD is also associated with increased all-cause mortality.
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