Left ventricular mass and function in children with GH deficiency before and during 12 months GH replacement therapy.
OBJECTIVE
This open, prospective study was designed to evaluate the effect of GH deficiency (GHD) on left ventricular (LV) mass (LVM) and performance, by echocardiography, and on lipid profile during childhood.


METHODS
Twelve prepubertal children with GHD (eight boys and four girls) aged 8.1 +/- 1.7 years were studied before and after 6 and 12 months of GH replacement therapy at a dose of GH of 30 micro g/kg/day. Twelve healthy children sex-, height-, weight- and body surface area-matched with the patients, served as controls.


METHODS
Echocardiography was performed at study entry and after 12 months both in GHD children and in controls. Only in GHD children, echocardiography was repeated also after 6 months of GH replacement. In all subjects, we measured LV posterior wall thickness (LVPWT), LV end-diastolic diameter (LVEDD), LVM index (LVMi), LV systolic and diastolic function.


RESULTS
At study entry, LVPWT (5.3 +/- 0.8 vs. 6.2 +/- 1.1 mm, P < 0.05), LVEDD (34.0 +/- 2.4 vs. 36.7 +/- 2.1 mm, P < 0.007) and LVMi (47.0 +/- 6.9 vs. 59.6 +/- 9.5 g/m2, P < 0.005) were significantly lower in GHD children than in controls. Lipid profile, heart rate, blood pressure, LV systolic function and indices of ventricular filling were similar in patients and controls. After 12 months of GH replacement therapy, LVPWT (6.1 +/- 0.7 mm, P < 0.0005), LVEDD (38.8 +/- 4.3 mm, P < 0.002) and LVMi (71.5 +/- 12.7 g/m2, P < 0.0005) significantly increased in GHD children compared to pretreatment values. In particular, after 12 months of therapy GHD children achieved a normal LVMi when compared to controls (60.7 +/- 8.6, P = ns). LVMi increase was significantly correlated with the increase in IGF-I level (r = 0.49; P < 0.004). LV systolic performance, diastolic filling and blood pressure did not change significantly during GH therapy. After 12 months of treatment, the atherogenic index, measured as total/high-density lipoprotein-cholesterol ratio (2.7 +/- 0.8) was significantly lower than both pretreatment (3.4 +/- 0.3, P < 0.03) and control values (3.8 +/- 1.1, P < 0.04).


CONCLUSIONS
GH deficiency in children affects heart morphology, by inducing a significant decrease in cardiac size, but does not modify cardiac function and lipid profile. Twelve months of GH replacement treatment normalizes cardiac mass, and reduces the atherogenic index.
Salerno
Mariacarolina
M
Department of Pediatrics, University Frederico II of Naples, Naples, Italy. salerno@unina.it
Esposito
Valentina
V
Spinelli
Letizia
L
Di Somma
Carolina
C
Farina
Vincenzo
V
Muzzica
Stefania
S
de Horatio
Laura Tanturri
LT
Lombardi
Gaetano
G
Colao
Annamaria
A
D016022:Case-Control Studies; D002648:Child; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D004452:Echocardiography; D005260:Female; D006339:Heart Rate; D006352:Heart Ventricles / Q000473:pathology; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D013599:Systole; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
D008076:Cholesterol, HDL; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D002784:Cholesterol