Introduction: GH deficiency (GHD) in adults is associated with impaired cardiac function, contributing to increased mortality due to cardiovascular disease. Research has shown that adults with GHD have high levels of brain natriuretic peptide as a measure of cardiac function. GH replacement therapy can improve cardiac function and lower BNP levels. The scarce research carried out in children appears to show that GHD is linked to decreased left-ventricle size and reduced left-ventricle mass, although heart function is unimpaired. Therapeutic action from childhood onwards could contribute to lowering mortality due to cardiovascular disease in GHD patients.
Aim: To evaluate the effects of GHD on cardiac function and left-ventricle mass, and the effects of GH replacement therapy on these.
Material and methods: This observational, prospective, case-control study examined 41 prepubertal children aged under 12 with diagnosed GHD before and 6 months after GH replacement therapy, and 41 age-matched healthy controls. The following were recorded: age, body surface area, blood pressure and heart rate; ecocardiographic morphological data (ventricular mass, left-ventricle systolic and diastolic diameter), cardiac function (LV systolic and diastolic function, E/A ratio, E/E ratio, isovolumic relaxation time); RV function (TAPSE); and BNP elevels. For statistical analysis, data were subjected to Students t test, with a significance level of P<0.05.
Results: Indexed left ventricular mass was lower in GHD patients than in controls; systolic and diastolic function were similarly normal, and no inter-group difference was found for heart-rate, blood-pressure or BN levels. After 6 months replacement therapy, indexed left ventricular mass had increased in GHD patients, while systolic and diastolic cardiac function remained normal.
Conclusions: GHD in children is associated with lower left ventricular mass, though cardiac function is unimpaired. GH replacement therapy prompts an increase in left ventricular mass without affecting normal systolic and diastolic function. Acting on risk factors from childhood onwards may help to reduce mortality due to cardiovascular disease in adults.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology