Cardiac status after childhood growth hormone treatment of Turner syndrome.
BACKGROUND
In Turner syndrome (TS), GH treatment is well established. Data on cardiac status after discontinuation of treatment are scarce. This study aimed to assess biventricular size and function in TS at least 6 months after discontinuation of GH treatment.


METHODS
TS patients and healthy women prospectively underwent cardiac magnetic resonance imaging. Ventricular two-dimensional tomographic cine data were acquired to obtain biventricular volume, mass, and ejection fraction. Atrioventricular valve flow measurements were performed using a two-dimensional flow-sensitized sequence. Flow velocity curves were calculated and indices of biventricular diastolic filling were derived.


RESULTS
Thirty-one patients [mean (sd) age 20 (2) yr, body surface area 1.75 (0.15) m(2), 5 (2) yr after GH discontinuation] and 23 normal control women [age 21 (2) yr, body surface area 1.80 (0.13) m(2)] were included. Compared with controls, patients had smaller mean end-diastolic volumes [right ventricle (RV), 84 (11) ml/m(2) vs. 79 (10), P = 0.02; left ventricle (LV), 81 (10) vs. 72 (9), P < 0.001], end-systolic volumes [RV 38 (7) ml/m(2) vs. 36 (6), P = 0.04; LV 34 (5) vs. 29 (4), P < 0.001], and stroke volumes [RV 46 (6) ml/m(2) vs. 43 (6), P = 0.03; LV, 47 (7) vs. 44 (4), P = 0.02]. Patients had a higher mean heart rate [79 (13) beats/min vs. 71 (10), P < 0.05]. Biventricular ejection fraction, mass, cardiac output, and diastolic filling pattern were comparable.


CONCLUSIONS
After discontinuation of GH treatment TS patients showed no myocardial hypertrophy and well-preserved biventricular function. Ventricular volumes were smaller in Turner patients, compared with controls, whereas mean heart rate was higher. These last observations may be part of the natural development in TS and not linked to GH treatment, which at this point we consider safe.
van den Berg
Jochem
J
Department of Pediatric Cardiology, Erasmus Medical Center, Sophia Children's Hospital, Dr Molewaterplein 60, Rotterdam, The Netherlands.
Bannink
Ellen M N
EM
Wielopolski
Piotr A
PA
Hop
Wim C J
WC
van Osch-Gevers
Lennie
L
Pattynama
Peter M T
PM
de Muinck Keizer-Schrama
Sabine M P F
SM
Helbing
Willem A
WA
D000328:Adult; D001794:Blood Pressure; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D014424:Turner Syndrome / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left
D019382:Human Growth Hormone