title: Long-term echocardiographic and cardioscintigraphic effects of growth hormone treatment in adults with Prader-Willi syndrome.
abstract: BACKGROUND
  In Prader-Willi syndrome (PWS), an altered GH secretion has been related to reduced cardiac mass and systolic function compared to controls.
  
  
  OBJECTIVE
  The objective was to evaluate the cardiovascular response to a 4-year GH therapy in adult PWS patients.
  
  
  METHODS
  Study participants were nine severely obese PWS adults (three females, six males) and 13 age-, gender-, and body mass index-matched obese controls.
  
  
  METHODS
  In an open-label prospective study, assessment of endocrine parameters and metabolic outcome, whole-body and abdominal fat scans, echocardiography, and radionuclide angiography in unstimulated and dobutamine-stimulated conditions were conducted at baseline and after 1 and 4 years of GH treatment.
  
  
  RESULTS
  GH treatment increased IGF-1 (P < .0001), decreased C-reactive protein levels (P < .05), improved visceral fat mass (P < .05), and achieved near-significant changes of fat and fat-free body mass in PWS patients. Left ventricle mass indexed by fat mass increased significantly after 1 and 4 years of GH therapy (P < .05) without evident abnormalities of diastolic function, while a trend toward a reduction of the ejection fraction was documented by echocardiography (P = .054). Radionuclide angiography revealed stable values throughout the study of both the left and right ventricle ejection fractions, although this was accompanied by a statistically nonsignificant reduction of the left ventricle filling rate. A positive association between lean body mass and left ventricle ejection fraction was evident during the study (P < .05).
  
  
  CONCLUSIONS
  GH therapy increased the cardiac mass of PWS adults without causing overt abnormalities of systolic and diastolic function. Although the association between lean mass and left ventricle ejection fraction during GH therapy corroborates a favorable systemic outcome of long-term GH treatment in adults with PWS, subtle longitudinal modifications of functional parameters advocate appropriate cardiac monitoring in the long-term therapeutic strategy for PWS.
authors.affiliation: Departments of General Medicine (P.M., M.S.), Metabolic Rehabilitation (A.M., A.S.), Cardiac Rehabilitation (L.A.G.), and Auxology (A.S., G.G.), Ospedale San Giuseppe, Instituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, I-28921 Verbania, Italy; Departments of Cardiology (C.M., E.E.) and Nuclear Medicine (R.C.), Fondazione Salvatore Maugeri, I-27100 Veruno, Italy; and Department of Translational Medicine (P.M., G.A.), Università del Piemonte Orientale, I-28100 Novara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marzullo
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcassa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Minocci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Campini
authors.forename: Ermanno
authors.initials: E
authors.lastname: Eleuteri
authors.forename: Luca Alessandro
authors.initials: LA
authors.lastname: Gondoni
authors.forename: Gianluca
authors.initials: G
authors.lastname: Aimaretti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sartorio
authors.forename: Massimo
authors.initials: M
authors.lastname: Scacchi
authors.forename: Graziano
authors.initials: G
authors.lastname: Grugni
mesh_terms: D000328:Adult; D001823:Body Composition / Q000187:drug effects; D015992:Body Mass Index; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D019382:Human Growth Hormone / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011218:Prader-Willi Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone