Background: Several metabolic abnormalities, including unfavourable lipid profile, impaired cardiac performance, muscle strength and endurance capacity have been documented in GH Deficiency (GHD) adults. Alterations in cardiac morphology and left ventricular function and early markers of cardiovascular risk have been also detected in GHD children; however, no studies have so far investigated the effects of GHD on physical performance and right ventricular (RV) function in childhood.
Objective and hypotheses: To evaluate the effect of GHD and GH therapy on physical performance and RV function in children.
Method: 18 GHD children (13.0±2.2 years) and 18 age-, sex- and BMI-matched controls performed cardiopulmonary exercise testing (CPX) and echocardiography before and after 12 months of GH therapy. CPX was performed according to a multistage treadmill protocol. Children were asked to perform the test until they were unable to continue it because of dyspnea or fatigue. Measurements of oxygen consumption (VO2) were taken at rest and during exercise. The maximum VO2 (VO2max) and maximum power output (Wpeak) were defined as the highest VO2 and power output values measured during the exercise. RV function was assessed recording the following measurements: RV fractional area change (RVFAC) and Tricuspid annular plane systolic excursion (TAPSE).
Results: GHD children compared to controls showed significantly reduced values of VO2max (22.8±4.8 vs 26.4±4.93 ml/Kg per min, P=0.03) and Wpeak (80.0±30 vs 101.0±31 watts, P=0.04) at baseline. No difference was found in RVFAC (51.39±7.16 vs 49.31±12.1%) and TAPSE (2.18±0.26 vs 2.06±0.3 mm). GH therapy was associated with a significant increase in VO2max (26.32±5.04; P=0.04) and a slight improvement in Wpeak (94.06±27.37). RVFAC and TAPSE did not significantly change during GH treatment.
Conclusion: Our results suggest that aerobic and anaerobic capacity are impaired in children with untreated GHD and are restored by few months of GH replacement therapy. No significant alterations were found in RV cardiac function.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology