Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic Heart Failure: Insights from the T.O.S.CA. GHD Study
Although mounting evidence supports the concept that growth hormone (GH) deficiency (GHD) affects cardiovascular function, no study has systematically investigated its prevalence and role in a large cohort of chronic heart failure (CHF) patients. Aim of this study is to assess the prevalence of GHD...
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| creator | Arcopinto, Michele Salzano, Andrea Giallauria, Francesco Bossone, Eduardo Isgaard, Jörgen Marra, Alberto M Bobbio, Emanuele Vriz, Olga Åberg, David N Masarone, Daniele De Paulis, Amato Saldamarco, Lavinia Vigorito, Carlo Formisano, Pietro Niola, Massimo Perticone, Francesco Bonaduce, Domenico Saccà, Luigi Colao, Annamaria Cittadini, Antonio |
| description | Although mounting evidence supports the concept that growth hormone (GH) deficiency (GHD) affects cardiovascular function, no study has systematically investigated its prevalence and role in a large cohort of chronic heart failure (CHF) patients. Aim of this study is to assess the prevalence of GHD in mild-to-moderate CHF and to explore clinical and functional correlates of GHD.
One-hundred thirty CHF patients underwent GH provocative test with GHRH+arginine and accordingly categorized into GH-deficiency (GHD, n = 88, age = 61.6±1.1 years, 68% men) and GH-sufficiency (GHS, n = 42, age = 63.6±1.5 years, 81% men) cohorts. Both groups received comprehensive cardiovascular examination and underwent Doppler echocardiography, cardiopulmonary exercise testing, and biochemical and hormonal assay.
GHD was detected in roughly 30% of CHF patients. Compared to GHD, GHS patients showed smaller end-diastolic and end-systolic LV volumes (-28%, p = .008 and -24%, p = .015, respectively), lower LV end-systolic wall stress (-21%, p = .03), higher RV performance (+18% in RV area change, p = .03), lower estimated systolic pulmonary artery pressure (-11%, p = .04), higher peak VO2 (+20%, p = .001) and increased ventilatory efficiency (-12% in VE/VCO2 slope, p = .002). After adjusting for clinical covariates (age, gender, and tertiles of LV ejection fraction, IGF-1, peak VO2, VE/VCO2 slope, and NT-proBNP), logistic multivariate analysis showed that peak VO2 (β = -1.92, SE = 1.67, p = .03), VE/VCO2 slope (β = 2.23, SE = 1.20, p = .02) and NT-proBNP (β = 2.48, SE = 1.02, p = .016), were significantly associated with GHD status. Finally, compared to GHS, GHD cohort showed higher all-cause mortality at median follow-up of 3.5 years (40% vs. 25%, p < .001, respectively), independent of age, sex, NT-proBNP, peak VO2 and LVEF.
GH deficiency identifies a subgroup of CHF patients characterized by impaired functional capacity, LV remodeling and elevated NT-proBNP levels. GHD is also associated with increased all-cause mortality. |
| doi_str_mv | 10.1371/journal.pone.0170058 |
| format | Article |
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One-hundred thirty CHF patients underwent GH provocative test with GHRH+arginine and accordingly categorized into GH-deficiency (GHD, n = 88, age = 61.6±1.1 years, 68% men) and GH-sufficiency (GHS, n = 42, age = 63.6±1.5 years, 81% men) cohorts. Both groups received comprehensive cardiovascular examination and underwent Doppler echocardiography, cardiopulmonary exercise testing, and biochemical and hormonal assay.
GHD was detected in roughly 30% of CHF patients. Compared to GHD, GHS patients showed smaller end-diastolic and end-systolic LV volumes (-28%, p = .008 and -24%, p = .015, respectively), lower LV end-systolic wall stress (-21%, p = .03), higher RV performance (+18% in RV area change, p = .03), lower estimated systolic pulmonary artery pressure (-11%, p = .04), higher peak VO2 (+20%, p = .001) and increased ventilatory efficiency (-12% in VE/VCO2 slope, p = .002). After adjusting for clinical covariates (age, gender, and tertiles of LV ejection fraction, IGF-1, peak VO2, VE/VCO2 slope, and NT-proBNP), logistic multivariate analysis showed that peak VO2 (β = -1.92, SE = 1.67, p = .03), VE/VCO2 slope (β = 2.23, SE = 1.20, p = .02) and NT-proBNP (β = 2.48, SE = 1.02, p = .016), were significantly associated with GHD status. Finally, compared to GHS, GHD cohort showed higher all-cause mortality at median follow-up of 3.5 years (40% vs. 25%, p < .001, respectively), independent of age, sex, NT-proBNP, peak VO2 and LVEF.
GH deficiency identifies a subgroup of CHF patients characterized by impaired functional capacity, LV remodeling and elevated NT-proBNP levels. GHD is also associated with increased all-cause mortality.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0170058</identifier><identifier>PMID: 28095492</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; anabolic deficiency ; anaerobic ; Analysis ; Arginine ; axis ; Basic Medicine ; Beta blockers ; binding protein-3 ; Biology and Life Sciences ; Blood pressure ; Cardiomyopathy ; Cardiovascular Physiological Phenomena ; Cardiovascular system ; Chronic Disease ; Cross-Sectional Studies ; depression ; dilated cardiomyopathy ; Doppler effect ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Exercise - physiology ; factor-i ; Female ; Gender ; Gene expression ; Growth hormone ; Growth hormone-releasing hormone ; Growth hormones ; Health aspects ; Heart ; Heart diseases ; Heart failure ; Heart Failure - physiopathology ; Human Growth Hormone - deficiency ; Humans ; hypopituitarism ; Insulin ; Insulin-like growth factor I ; Insulin-like growth factors ; Internal medicine ; Male ; Medicine and Health Sciences ; Medicinska och farmaceutiska grundvetenskaper ; Mental depression ; Middle Aged ; Mortality ; Multivariate analysis ; Outcome and process assessment (Medical care) ; Patients ; People and Places ; Physiology ; Population ; predictor ; Pulmonary artery ; Quality of life ; Research and Analysis Methods ; Rodents ; Science & Technology - Other Topics ; Slopes ; Somatotropin ; therapy ; threshold ; Vanadium oxides</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0170058-e0170058</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Arcopinto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Arcopinto et al 2017 Arcopinto et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c763t-bf7bd1505f053f92e0d6737b348f2a2a6734a180a352b408e7af2c7fa97a3a433</citedby><cites>FETCH-LOGICAL-c763t-bf7bd1505f053f92e0d6737b348f2a2a6734a180a352b408e7af2c7fa97a3a433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240983/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240983/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28095492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/250652$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Arcopinto, Michele</creatorcontrib><creatorcontrib>Salzano, Andrea</creatorcontrib><creatorcontrib>Giallauria, Francesco</creatorcontrib><creatorcontrib>Bossone, Eduardo</creatorcontrib><creatorcontrib>Isgaard, Jörgen</creatorcontrib><creatorcontrib>Marra, Alberto M</creatorcontrib><creatorcontrib>Bobbio, Emanuele</creatorcontrib><creatorcontrib>Vriz, Olga</creatorcontrib><creatorcontrib>Åberg, David N</creatorcontrib><creatorcontrib>Masarone, Daniele</creatorcontrib><creatorcontrib>De Paulis, Amato</creatorcontrib><creatorcontrib>Saldamarco, Lavinia</creatorcontrib><creatorcontrib>Vigorito, Carlo</creatorcontrib><creatorcontrib>Formisano, Pietro</creatorcontrib><creatorcontrib>Niola, Massimo</creatorcontrib><creatorcontrib>Perticone, Francesco</creatorcontrib><creatorcontrib>Bonaduce, Domenico</creatorcontrib><creatorcontrib>Saccà, Luigi</creatorcontrib><creatorcontrib>Colao, Annamaria</creatorcontrib><creatorcontrib>Cittadini, Antonio</creatorcontrib><creatorcontrib>T.O.S.CA. (Trattamento Ormonale Scompenso CArdiaco) Investigators</creatorcontrib><title>Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic Heart Failure: Insights from the T.O.S.CA. GHD Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Although mounting evidence supports the concept that growth hormone (GH) deficiency (GHD) affects cardiovascular function, no study has systematically investigated its prevalence and role in a large cohort of chronic heart failure (CHF) patients. Aim of this study is to assess the prevalence of GHD in mild-to-moderate CHF and to explore clinical and functional correlates of GHD.
One-hundred thirty CHF patients underwent GH provocative test with GHRH+arginine and accordingly categorized into GH-deficiency (GHD, n = 88, age = 61.6±1.1 years, 68% men) and GH-sufficiency (GHS, n = 42, age = 63.6±1.5 years, 81% men) cohorts. Both groups received comprehensive cardiovascular examination and underwent Doppler echocardiography, cardiopulmonary exercise testing, and biochemical and hormonal assay.
GHD was detected in roughly 30% of CHF patients. Compared to GHD, GHS patients showed smaller end-diastolic and end-systolic LV volumes (-28%, p = .008 and -24%, p = .015, respectively), lower LV end-systolic wall stress (-21%, p = .03), higher RV performance (+18% in RV area change, p = .03), lower estimated systolic pulmonary artery pressure (-11%, p = .04), higher peak VO2 (+20%, p = .001) and increased ventilatory efficiency (-12% in VE/VCO2 slope, p = .002). After adjusting for clinical covariates (age, gender, and tertiles of LV ejection fraction, IGF-1, peak VO2, VE/VCO2 slope, and NT-proBNP), logistic multivariate analysis showed that peak VO2 (β = -1.92, SE = 1.67, p = .03), VE/VCO2 slope (β = 2.23, SE = 1.20, p = .02) and NT-proBNP (β = 2.48, SE = 1.02, p = .016), were significantly associated with GHD status. Finally, compared to GHS, GHD cohort showed higher all-cause mortality at median follow-up of 3.5 years (40% vs. 25%, p < .001, respectively), independent of age, sex, NT-proBNP, peak VO2 and LVEF.
GH deficiency identifies a subgroup of CHF patients characterized by impaired functional capacity, LV remodeling and elevated NT-proBNP levels. GHD is also associated with increased all-cause mortality.</description><subject>Age</subject><subject>anabolic deficiency</subject><subject>anaerobic</subject><subject>Analysis</subject><subject>Arginine</subject><subject>axis</subject><subject>Basic Medicine</subject><subject>Beta blockers</subject><subject>binding protein-3</subject><subject>Biology and Life Sciences</subject><subject>Blood pressure</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular Physiological Phenomena</subject><subject>Cardiovascular system</subject><subject>Chronic Disease</subject><subject>Cross-Sectional Studies</subject><subject>depression</subject><subject>dilated cardiomyopathy</subject><subject>Doppler effect</subject><subject>Echocardiography</subject><subject>Echocardiography, Doppler</subject><subject>Electrocardiography</subject><subject>Exercise - physiology</subject><subject>factor-i</subject><subject>Female</subject><subject>Gender</subject><subject>Gene expression</subject><subject>Growth hormone</subject><subject>Growth hormone-releasing hormone</subject><subject>Growth hormones</subject><subject>Health aspects</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart Failure - physiopathology</subject><subject>Human Growth Hormone - deficiency</subject><subject>Humans</subject><subject>hypopituitarism</subject><subject>Insulin</subject><subject>Insulin-like growth factor I</subject><subject>Insulin-like growth factors</subject><subject>Internal medicine</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Medicinska och farmaceutiska grundvetenskaper</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Outcome and process assessment (Medical care)</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physiology</subject><subject>Population</subject><subject>predictor</subject><subject>Pulmonary artery</subject><subject>Quality of life</subject><subject>Research and Analysis Methods</subject><subject>Rodents</subject><subject>Science & Technology - Other Topics</subject><subject>Slopes</subject><subject>Somatotropin</subject><subject>therapy</subject><subject>threshold</subject><subject>Vanadium oxides</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9Fu0zAUhiMEYjB4AwSWkBBIa3DsOE64QKo6tlaa1IkNuLQcx048JXaxE0ZfiOfEod20oF1MuXBy_P1_zjn2iaJXCYwTTJOPV3ZwhrfxxhoZw4RCSPJH0bOkwGiWIYgf33k_iJ57fxUInGfZ0-gA5bAgaYGeRX9Onb3uG7C0rgtG4FgqLbQ0YgtWHsy9t0LzXlbgWgfqh3VeggV3leYCnAxG9NqaI3DebL0WvAXn0qngxI2QR4CbCqyHXthOAm3AonHWaAGWkrsenHDdDk5-Aivjdd30HihnO9A3ElzG6_giXsxjcLo8Bhf9UG1fRE8Ub718uV8Po28nXy4Xy9nZ-nS1mJ_NBM1wPysVLauEQKJCqapAElYZxbTEaa4QRzx8pDzJIccElSnMJeUKCap4QTnmKcaH0Zud76a1nu1b7FmSkyJNC5ygQKx2RGX5Fds43XG3ZZZr9i9gXc1CeVq0kklcSpgSkkFRpgJnecgIZ4ooldKEFmnwmu28_LXcDOXErR42LITqgXnJEIEZGf_9eZ_dUHayEtL0jrcT2XTH6IbV9hcjKIVFPpb3fm_g7M9B-p512gvZttxIO4x1ZoFCWZE9BE0IhYTSgL79D72_cXuq5qE32igbUhSjKZunlOYFyhEJVHwPFZ5KdlqEG6p0iE8EHyaCwPTyd1_zwXu2uvj6cHb9fcq-u8M2krd94207jBfeT8F0BwpnvXdS3Z5HAtk4qTfdYOOksv2kBtnru2d5K7oZTfwX7ug30w</recordid><startdate>20170117</startdate><enddate>20170117</enddate><creator>Arcopinto, Michele</creator><creator>Salzano, Andrea</creator><creator>Giallauria, Francesco</creator><creator>Bossone, Eduardo</creator><creator>Isgaard, Jörgen</creator><creator>Marra, Alberto M</creator><creator>Bobbio, Emanuele</creator><creator>Vriz, Olga</creator><creator>Åberg, David N</creator><creator>Masarone, Daniele</creator><creator>De Paulis, Amato</creator><creator>Saldamarco, Lavinia</creator><creator>Vigorito, Carlo</creator><creator>Formisano, Pietro</creator><creator>Niola, Massimo</creator><creator>Perticone, Francesco</creator><creator>Bonaduce, Domenico</creator><creator>Saccà, Luigi</creator><creator>Colao, Annamaria</creator><creator>Cittadini, Antonio</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>F1U</scope><scope>DOA</scope></search><sort><creationdate>20170117</creationdate><title>Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic Heart Failure: Insights from the T.O.S.CA. GHD Study</title><author>Arcopinto, Michele ; Salzano, Andrea ; Giallauria, Francesco ; Bossone, Eduardo ; Isgaard, Jörgen ; Marra, Alberto M ; Bobbio, Emanuele ; Vriz, Olga ; Åberg, David N ; Masarone, Daniele ; De Paulis, Amato ; Saldamarco, Lavinia ; Vigorito, Carlo ; Formisano, Pietro ; Niola, Massimo ; Perticone, Francesco ; Bonaduce, Domenico ; Saccà, Luigi ; Colao, Annamaria ; Cittadini, Antonio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c763t-bf7bd1505f053f92e0d6737b348f2a2a6734a180a352b408e7af2c7fa97a3a433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age</topic><topic>anabolic deficiency</topic><topic>anaerobic</topic><topic>Analysis</topic><topic>Arginine</topic><topic>axis</topic><topic>Basic Medicine</topic><topic>Beta blockers</topic><topic>binding protein-3</topic><topic>Biology and Life Sciences</topic><topic>Blood pressure</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular Physiological Phenomena</topic><topic>Cardiovascular system</topic><topic>Chronic Disease</topic><topic>Cross-Sectional Studies</topic><topic>depression</topic><topic>dilated cardiomyopathy</topic><topic>Doppler effect</topic><topic>Echocardiography</topic><topic>Echocardiography, Doppler</topic><topic>Electrocardiography</topic><topic>Exercise - physiology</topic><topic>factor-i</topic><topic>Female</topic><topic>Gender</topic><topic>Gene expression</topic><topic>Growth hormone</topic><topic>Growth hormone-releasing hormone</topic><topic>Growth hormones</topic><topic>Health aspects</topic><topic>Heart</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Heart Failure - physiopathology</topic><topic>Human Growth Hormone - deficiency</topic><topic>Humans</topic><topic>hypopituitarism</topic><topic>Insulin</topic><topic>Insulin-like growth factor I</topic><topic>Insulin-like growth factors</topic><topic>Internal medicine</topic><topic>Male</topic><topic>Medicine and Health Sciences</topic><topic>Medicinska och farmaceutiska grundvetenskaper</topic><topic>Mental depression</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Outcome and process assessment (Medical care)</topic><topic>Patients</topic><topic>People and Places</topic><topic>Physiology</topic><topic>Population</topic><topic>predictor</topic><topic>Pulmonary artery</topic><topic>Quality of life</topic><topic>Research and Analysis Methods</topic><topic>Rodents</topic><topic>Science & Technology - Other Topics</topic><topic>Slopes</topic><topic>Somatotropin</topic><topic>therapy</topic><topic>threshold</topic><topic>Vanadium oxides</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arcopinto, Michele</creatorcontrib><creatorcontrib>Salzano, Andrea</creatorcontrib><creatorcontrib>Giallauria, Francesco</creatorcontrib><creatorcontrib>Bossone, Eduardo</creatorcontrib><creatorcontrib>Isgaard, Jörgen</creatorcontrib><creatorcontrib>Marra, Alberto M</creatorcontrib><creatorcontrib>Bobbio, Emanuele</creatorcontrib><creatorcontrib>Vriz, Olga</creatorcontrib><creatorcontrib>Åberg, David N</creatorcontrib><creatorcontrib>Masarone, Daniele</creatorcontrib><creatorcontrib>De Paulis, Amato</creatorcontrib><creatorcontrib>Saldamarco, Lavinia</creatorcontrib><creatorcontrib>Vigorito, Carlo</creatorcontrib><creatorcontrib>Formisano, Pietro</creatorcontrib><creatorcontrib>Niola, Massimo</creatorcontrib><creatorcontrib>Perticone, Francesco</creatorcontrib><creatorcontrib>Bonaduce, Domenico</creatorcontrib><creatorcontrib>Saccà, Luigi</creatorcontrib><creatorcontrib>Colao, Annamaria</creatorcontrib><creatorcontrib>Cittadini, Antonio</creatorcontrib><creatorcontrib>T.O.S.CA. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Göteborgs universitet</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arcopinto, Michele</au><au>Salzano, Andrea</au><au>Giallauria, Francesco</au><au>Bossone, Eduardo</au><au>Isgaard, Jörgen</au><au>Marra, Alberto M</au><au>Bobbio, Emanuele</au><au>Vriz, Olga</au><au>Åberg, David N</au><au>Masarone, Daniele</au><au>De Paulis, Amato</au><au>Saldamarco, Lavinia</au><au>Vigorito, Carlo</au><au>Formisano, Pietro</au><au>Niola, Massimo</au><au>Perticone, Francesco</au><au>Bonaduce, Domenico</au><au>Saccà, Luigi</au><au>Colao, Annamaria</au><au>Cittadini, Antonio</au><aucorp>T.O.S.CA. (Trattamento Ormonale Scompenso CArdiaco) Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic Heart Failure: Insights from the T.O.S.CA. GHD Study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-17</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0170058</spage><epage>e0170058</epage><pages>e0170058-e0170058</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Although mounting evidence supports the concept that growth hormone (GH) deficiency (GHD) affects cardiovascular function, no study has systematically investigated its prevalence and role in a large cohort of chronic heart failure (CHF) patients. Aim of this study is to assess the prevalence of GHD in mild-to-moderate CHF and to explore clinical and functional correlates of GHD.
One-hundred thirty CHF patients underwent GH provocative test with GHRH+arginine and accordingly categorized into GH-deficiency (GHD, n = 88, age = 61.6±1.1 years, 68% men) and GH-sufficiency (GHS, n = 42, age = 63.6±1.5 years, 81% men) cohorts. Both groups received comprehensive cardiovascular examination and underwent Doppler echocardiography, cardiopulmonary exercise testing, and biochemical and hormonal assay.
GHD was detected in roughly 30% of CHF patients. Compared to GHD, GHS patients showed smaller end-diastolic and end-systolic LV volumes (-28%, p = .008 and -24%, p = .015, respectively), lower LV end-systolic wall stress (-21%, p = .03), higher RV performance (+18% in RV area change, p = .03), lower estimated systolic pulmonary artery pressure (-11%, p = .04), higher peak VO2 (+20%, p = .001) and increased ventilatory efficiency (-12% in VE/VCO2 slope, p = .002). After adjusting for clinical covariates (age, gender, and tertiles of LV ejection fraction, IGF-1, peak VO2, VE/VCO2 slope, and NT-proBNP), logistic multivariate analysis showed that peak VO2 (β = -1.92, SE = 1.67, p = .03), VE/VCO2 slope (β = 2.23, SE = 1.20, p = .02) and NT-proBNP (β = 2.48, SE = 1.02, p = .016), were significantly associated with GHD status. Finally, compared to GHS, GHD cohort showed higher all-cause mortality at median follow-up of 3.5 years (40% vs. 25%, p < .001, respectively), independent of age, sex, NT-proBNP, peak VO2 and LVEF.
GH deficiency identifies a subgroup of CHF patients characterized by impaired functional capacity, LV remodeling and elevated NT-proBNP levels. GHD is also associated with increased all-cause mortality.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28095492</pmid><doi>10.1371/journal.pone.0170058</doi><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| subjects | Age anabolic deficiency anaerobic Analysis Arginine axis Basic Medicine Beta blockers binding protein-3 Biology and Life Sciences Blood pressure Cardiomyopathy Cardiovascular Physiological Phenomena Cardiovascular system Chronic Disease Cross-Sectional Studies depression dilated cardiomyopathy Doppler effect Echocardiography Echocardiography, Doppler Electrocardiography Exercise - physiology factor-i Female Gender Gene expression Growth hormone Growth hormone-releasing hormone Growth hormones Health aspects Heart Heart diseases Heart failure Heart Failure - physiopathology Human Growth Hormone - deficiency Humans hypopituitarism Insulin Insulin-like growth factor I Insulin-like growth factors Internal medicine Male Medicine and Health Sciences Medicinska och farmaceutiska grundvetenskaper Mental depression Middle Aged Mortality Multivariate analysis Outcome and process assessment (Medical care) Patients People and Places Physiology Population predictor Pulmonary artery Quality of life Research and Analysis Methods Rodents Science & Technology - Other Topics Slopes Somatotropin therapy threshold Vanadium oxides |
| title | Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic Heart Failure: Insights from the T.O.S.CA. GHD Study |
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