Growth Hormone Therapy in Heart Failure: Where Are We Now?

Catherine Demers, MD, MSc, Robert S. McKelvie, MD, PhD

Disclosures

CHF. 2003;9(2) 

In This Article

Nonrandomized Human Studies Evaluating the Role of GH for the Treatment of HF

Small, short-term, nonrandomized studies have disclosed beneficial effects of recombinant human GH (rhGH) treatment, in addition to angiotensin-converting enzyme inhibitors, in HF patients with idiopathic dilated cardiomyopathy and ischemic cardiomyopathy ( Table I ).[38,39,40,41,42,43,44] Fazio et al.[38] were the first to demonstrate significant improvements in cardiac function, functional capacity, and hemodynamic parameters in seven patients with dilated cardiomyopathy in an uncontrolled setting. In most studies, cardiac function improved significantly, with decreases in left ventricular end-diastolic and end-systolic dimensions, improvement in left ventricular ejection fraction, and decreased left ventricular wall stress, with increased wall thickness and mass.[25,38,41,43] Changes in cardiac function persisted at 3 months following discontinuation of the drug.[38,41] In these studies, New York Heart Association (NYHA) functional classification, exercise capacity, and quality of life were also improved at 3 months of rhGH therapy.[25,38,41,43,44] A study of 10 patients with ischemic cardiomyopathy treated with rhGH for 6 months showed that wall thickness, left ventricular dimensions, and left ventricular ejection fraction remained unchanged.[44]

Short-term (24-hour) continuous intravenous infusion of rhGH in patients with ischemic and idiopathic dilated cardiomyopathy have demonstrated similar hemodynamic benefits, with an increase in cardiac index and decreased systemic vascular resistance, pulmonary artery pressure, wedge pressure, and pulmonary vascular resistance, without an increase in heart rate.[42,45] GH may act partly as an inotropic agent in combination with vasodilatory effects in the acute administration of this agent. Myocardial norepinephrine release and plasma aldosterone concentration in response to exercise were significantly decreased in a small group of patients with idiopathic dilated cardiomyopathy.[46] Following discontinuation of rhGH treatment, the plasma aldosterone concentration returned to normal.

In most studies, rhGH was well tolerated, with no significant side effects reported. Worsening of ventricular arrhythmias was reported in one study evaluating five patients with idiopathic dilated cardiomyopathy (mean left ventricular ejection fraction of 22%), which returned to baseline following the discontinuation of rhGH therapy.[25] In a study evaluating rhGH administration in 10 patients with ischemic cardiomyopathy compared to a control group, mean blood glucose and insulin levels were slightly elevated following treatment with GH, but this was not statistically significant.[44] GH therapy was discontinued in one patient because of episodes of sustained and nonsustained ventricular tachycardia, and in one due to worsening HF leading to heart transplantation.[44]

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