Aims

Growth hormone (GH) therapy in heart failure (HF) is controversial. We investigated the cardiovascular effects of GH in patients with chronic HF due to ischemic heart disease.

Methods

In a double-blind, placebo-controlled trial, we randomly assigned 37 patients (mean age 66 years; 95% male) with ischemic HF (ejection fraction [EF] < 40%) to a 9-month treatment with either recombinant human GH (1.4 mg every other day) or placebo, with subsequent 3-month treatment-free follow-up. The primary outcome was change in left ventricular (LV) end-systolic volume measured by cardiac magnetic resonance (CMR). Secondary outcomes comprised changes in cardiac structure and EF. Prespecified tertiary outcomes included changes in New York Heat Association (NYHA) functional class and quality of life (QoL), as well as levels of insulin-like growth factor-1 (IGF-1) and N-terminal pro-brain natriuretic peptide (NT-proBNP).

Results

No changes in cardiac structure or systolic function were identified in either treatment group; nor did GH treatment affect QoL or functional class. In the GH group, circulating levels of IGF-1 doubled from baseline (+105%; p < 0.001) and NT-proBNP levels halved (−48%; p < 0.001) during the treatment period, with subsequently a partial return of both towards baseline levels. No changes in IGF-1 or NT-proBNP were observed in the placebo group at any time during the study.

Conclusion

In patients with chronic ischemic HF, nine months of GH treatment was associated with significant increases in levels of IGF-1 and reductions in levels of NT-proBNP, but did not affect cardiac structure, systolic function or functional capacity.

中文翻译：

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生长激素治疗对缺血性心力衰竭患者循环NT-proBNP水平的影响

宗旨

心力衰竭 (HF) 中的生长激素 (GH) 治疗存在争议。我们研究了 GH 对缺血性心脏病导致的慢性 HF 患者的心血管影响。

方法

在一项双盲、安慰剂对照试验中，我们将 37 名缺血性 HF（射血分数 [EF] < 40%）患者（平均年龄 66 岁；95% 男性）随机分配至接受重组人 GH 治疗的 9 个月（每隔一天 1.4 毫克）或安慰剂，随后进行 3 个月的无治疗随访。主要结果是通过心脏磁共振 (CMR) 测量的左心室 (LV) 收缩末期容积的变化。次要结果包括心脏结构和 EF 的变化。预先指定的三级结果包括纽约热火协会 (NYHA) 功能等级和生活质量 (QoL) 的变化，以及胰岛素样生长因子-1 (IGF-1) 和 N 端脑钠肽前体的水平。 NT-proBNP）。

结果

任一治疗组均未发现心脏结构或收缩功能发生变化；GH 治疗也不影响 QoL 或功能等级。在 GH 组中，治疗期间 IGF-1 的循环水平比基线增加了一倍（+105%；p  < 0.001），NT-proBNP 水平减半（-48%；p  < 0.001），随后两者部分恢复接近基线水平。在研究期间的任何时间，安慰剂组均未观察到 IGF-1 或 NT-proBNP 的变化。

结论

在慢性缺血性 HF 患者中，9 个月的 GH 治疗与 IGF-1 水平显着增加和 NT-proBNP 水平降低有关，但不影响心脏结构、收缩功能或功能容量。