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Endocrine response in cardiogenic shock complicating myocardial infarction: the prognostic value of growth hormone
Insights
Growth hormone (GH) levels did not predict outcomes in cardiogenic shock (CS). However, declining insulin-like growth factor-1 (IGF-1) levels in CS patients correlated with disease severity and mortality risk.
Area of Science:
- Cardiology
- Endocrinology
- Biomarkers
Background:
- Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI) with high mortality.
- Hormonal changes during CS may offer prognostic information.
- The role of insulin-like growth factor-1 (IGF-1) in CS is not well understood, despite its known cardioprotective effects.
Purpose of the Study:
- To investigate the temporal changes in growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels in patients with CS.
- To assess the prognostic value of these hormonal changes in relation to survival outcomes.
- To explore potential differences in GH and IGF-1 levels based on age and sex.
Main Methods:
- Analysis of data from the Halle-Cardiogenic Shock Registry, including 41 AMI patients with CS.
- Measurement of GH and IGF-1 levels at admission and on days 1, 2, and 4 post-percutaneous coronary intervention.
- Comparison of hormone levels between survivors and non-survivors, and stratified by age and sex.
Main Results:
- GH levels were generally within the normal range and did not differ significantly between survivors and non-survivors.
- IGF-1 levels were at the lower end of normal and showed a trend of decline over time, particularly in non-survivors.
- Non-survivors exhibited a more rapid decline in IGF-1 compared to survivors, who maintained stable levels. Younger and male patients had higher IGF-1 levels.
Conclusions:
- GH levels do not appear to have prognostic value in CS.
- A decline in IGF-1 levels is associated with disease severity, potentially indicating hepatic dysfunction, and may serve as a prognostic biomarker in CS.
- IGF-1 warrants further investigation as a therapeutic target for metabolic regulation and improving recovery in CS patients.
Abstract:
Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction (AMI) with high mortality. Hormonal alterations during CS may offer prognostic insights. While growth hormone (GH) dynamics have been studied in heart failure, the role of insulin-like growth factor-1 (IGF-1) in CS remains unclear. IGF-1 exerts cardioprotective effects, including reducing myocardial apoptosis after ischemia-reperfusion injury. This study examines temporal changes in GH and IGF-1 levels in CS and their prognostic value. The Halle-Cardiogenic Shock Registry included 41 AMI patients with CS. GH and IGF-1 levels were measured at admission and on day 1, 2 and 4 post-percutaneous coronary intervention. Differences were analyzed between survivors and non-survivors, as well as by age (<70 vs ≥70 years) and sex. We found that at admission, GH levels (2.86 ± 0.78 microg/L) were within the normal range in 75.6% of patients and showed no significant differences between survivors and non-survivors. IGF-1 levels (76.23 ± 5.67 microg/L) were at the lower end of normal and declined to 66.8 microg/L at 48-72 h (P = 0.14). Non-survivors had a more rapid IGF-1 decline, while survivors maintained stable levels. IGF-1 was higher in younger and male patients, while older and female patients showed a greater decline. We conclude that GH levels remained stable and lacked prognostic value, while IGF-1 decline correlated with disease severity and possible hepatic dysfunction. IGF-1 may serve as a biomarker for risk stratification and a therapeutic target for metabolic regulation and recovery in CS, warranting further investigation.
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