title: Characterisation of myocardial structure and function in adult-onset growth hormone deficiency using cardiac magnetic resonance.
abstract: Growth hormone (GH) can profoundly influence cardiac function. While GH excess causes well-defined cardiac pathology, fewer data are available regarding the more subtle cardiac changes seen in GH deficiency (GHD). This preliminary study uses cardiac magnetic resonance imaging (CMR) to assess myocardial structure and function in GHD. Ten adult-onset GHD patients underwent CMR, before and after 6 and 12 months of GH replacement. They were compared to 10 age-matched healthy controls and sex-matched healthy controls. Left ventricular (LV) mass index (LVMi) increased with 1 year of GH replacement (53.8 vs. 57.0 vs. 57.3 g/m2, analysis of variance p = 0.0229). Compared to controls, patients showed a trend towards reduced LVMi at baseline (51.4 vs. 60.0 g/m2, p = 0.0615); this difference was lost by 1 year of GH treatment (57.3 vs. 59.9 g/m2, p = 0.666). Significantly reduced aortic area was observed in GHD (13.2 vs. 19.0 cm2/m2, p = 0.001). This did not change with GH treatment. There were no differences in other LV parameters including end-diastolic volume index (EDVi), end-systolic volume index, stroke volume index (SVi), cardiac index and ejection fraction. There was a trend towards reduced baseline right ventricular (RV)SVi (44.1 vs. 49.1 ml/m2, p = 0.0793) and increased RVEDVi over 1 year (70.3 vs. 74.3 vs. 73.8 ml/m2, p = 0.062). Two patients demonstrated interstitial expansion, for example with fibrosis, and three myocardial ischaemia as assessed by late gadolinium enhancement and stress perfusion. The increased sensitivity of CMR to subtle cardiac changes demonstrates that adult-onset GHD patients have reduced aortic area and LVMi increases after 1 year of GH treatment. These early data should be studied in larger studies in the future.
authors.affiliation: Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
authors.forename: Julia D J
authors.initials: JD
authors.lastname: Thomas
authors.affiliation: Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.|NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Dattani
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Filip
authors.initials: F
authors.lastname: Zemrak
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Burchell
authors.affiliation: Department of Endocrinology, St Bartholomew's Hospital, London, UK.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Akker
authors.affiliation: University of Cambridge, Metabolic Research Laboratories, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Gurnell
authors.affiliation: Oxford Centre for Endocrinology, Diabetes and Metabolism, University of Oxford, Oxford, UK.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Grossman
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: L Ceri
authors.initials: LC
authors.lastname: Davies
authors.affiliation: Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. m.korbonits@qmul.ac.uk.
authors.forename: Márta
authors.initials: M
authors.lastname: Korbonits
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D005355:Fibrosis; D005682:Gadolinium; D013006:Growth Hormone / Q000172:deficiency*; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009206:Myocardium / Q000473:pathology*; D010900:Pituitary Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology
chemical_list: C583557:IGF1 protein, human; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D005682:Gadolinium