Growth hormone therapy in congestive heart failure due to left ventricular systolic dysfunction: a meta-analysis.
OBJECTIVE
To examine the efficacy and safety of recombinant human growth hormone (rhGH) therapy in congestive heart failure (CHF) by conducting a meta-analysis of clinical studies.


METHODS
We searched 3 literature databases (MEDLINE, EMBASE, and the Cochrane Register) for clinical studies of rhGH therapy in CHF due to systolic dysfunction and conducted a meta-analysis.


RESULTS
Therapy with rhGH appears to have beneficial clinical effects (weighted mean difference [95% confidence interval]) in CHF including improved exercise duration (1.9 min [1.1-2.7]), maximum oxygen consumption (2.1 mL x kg(-1) x min(-1) [1.2-3.0]), and New York Heart Association class (-0.9 [-1.5 to -0.3]). There were salutary hemodynamic effects of rhGH therapy, including increased cardiac output (0.4 L x min(-1) [0.1-0.6]) and decreased systemic vascular resistance (-177 dyn x s x cm(-5) [-279 to -74]). Among rhGH-treated patients, left ventricular (LV) ejection fraction improved (4.3% [2.2-6.4]). Despite increases in LV mass and wall thickness, there were no adverse effects on diastolic function. Subgroup analyses suggest that study design and treatment duration may influence some of the treatment effects. Most of the beneficial effects were driven by either uncontrolled or longer duration studies. Administration of rhGH therapy slightly increased the risk for ventricular arrhythmia; however, this finding was driven by a single small study.


CONCLUSIONS
rhGH therapy may have beneficial cardiovascular effects in CHF caused by LV systolic dysfunction. The possibility of proarrhythmia associated with rhGH therapy requires further study. Larger randomized trials with longer treatment duration are needed to fully elucidate the efficacy and safety of rhGH therapy in this patient population.
Tritos
Nicholas A
NA
Department of Endocrinology, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA. Nicholas.A.Tritos@Lahey.org
Danias
Peter G
PG
D000328:Adult; D000368:Aged; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D018849:Controlled Clinical Trials as Topic; D015444:Exercise / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology*; D054143:Heart Failure, Systolic / Q000188:drug therapy; D019382:Human Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000150:complications*
D019382:Human Growth Hormone