The influence of growth hormone therapy on ultrasound myocardial tissue characterization in patients with childhood onset GH deficiency.
BACKGROUND
In growth hormone deficiency (GHD), a reduction in left ventricular mass (LV-mass) and impairment of systolic function has been shown. In this study, we investigated the effects of 12 months of GH replacement therapy on cardiac structure and functional indices measured by echocardiographic techniques in adult patients with childhood onset GH deficiency.


METHODS
Sixteen patients (age 42.3+/-13.1 years, 10 males) were investigated before and after 12 months of GH treatment at a dose of 0.02 IU/kg/day (7 microg/kg/day). Echocardiography was performed including the ultrasound myocardial tissue characterization technique. We measured two parameters of the ultrasonic tissue characterization with integrated backscatter: the magnitude of the cardiac-cycle-dependent variation in integrated backscatter signals (CV-IBS) and the mean value of integrated backscatter signals calibrated by the pericardium (cal-IBS).


RESULTS
Left ventricular diameter and wall thickness did not change after GH treatment, although systolic increase in interventricular septum thickness (IVS%) and systolic increase in posterior wall thickness (PWT%) increased significantly (IVS% 52.2+/-31.9% vs. 67.3+/-30.4% and PWT% 48.7+/-20.2% vs. 58.0+/-17.7%, p<0.01 and p<0.01, respectively). Ejection fraction increased from 56.2+/-7.2% to 63.2+/-6.1% (p<0.01). LV-mass index did not change after GH treatment (78.4+/-22.1 vs. 81.9+/-21.1 g/m(2)). CV-IBS increased significantly after GH treatment (p<0.05), in both the interventricular septum and the left ventricular posterior wall (4.7+/-1.5 vs. 5.8+/-1.9 dB for the interventricular septum, 4.9+/-1.8 vs. 6.5+/-2.4 dB for the left ventricular posterior wall, p<0.05 and p<0.05, respectively). Cal-IBS also increased significantly after GH treatment (-23.5+/-4.1 vs.-21.8+/-4.2 dB for the interventricular septum, -23.0+/-4.4 vs. -21.8+/-4.3 dB for the left ventricular posterior wall, p<0.01 and p<0.05, respectively).


CONCLUSIONS
Twelve months GH treatment in adults with childhood onset GHD resulted in improvement of cardiac contractile performance. Observed changes in cal-IBS and CV-IBS suggest that GH treatment in this patient group can lead to a further somatic maturation of the heart, probably not accomplished previously.
Minczykowski
Andrzej
A
Department of Cardiology-Intensive Therapy, University School of Medical Sciences in Poznan, Przybyszewskiego 49, Poznan 60-355, Poland. aminczyk@poczta.clinika.pl
Gryczynska
Maria
M
Ziemnicka
Katarzyna
K
Sowinski
Jerzy
J
Wysocki
Henryk
H
D000293:Adolescent; D000328:Adult; D004334:Drug Administration Schedule; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency* / Q000494:pharmacology*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D011994:Recombinant Proteins / Q000494:pharmacology
D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I