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CLINICAL STUDY

Growth hormone corrects vascular dysfunction in patients with chronic heart failure

^* Department of Internal Medicine and Cardiovascular Sciences, University Federico II School of Medicine, Naples, Italy

Manuscript received June 12, 2001; revised manuscript received September 4, 2001, accepted September 7, 2001.

^* Reprint requests and correspondence: Dr. Luigi Saccà, Medicina Interna, Via Pansini 5, 80131 Napoli, Italy.
sacca{at}unina.it

OBJECTIVES: The goal of this study was to test the hypothesis that growth hormone (GH) administration to patients with chronic heart failure (CHF) corrects their vascular dysfunction.

BACKGROUND: Endothelial dysfunction is a prominent feature of CHF. Recent evidence indicates that GH plays a role in vascular reactivity.

METHODS: We studied vascular reactivity in 16 patients with CHF (New York Heart Association class II to III) before and after three months of GH (4 IU subcutaneously every other day) or placebo administration in a randomized, double-blind trial. We measured forearm blood flow (FBF) by strain-gauge plethysmography during intrabrachial, graded infusion of acetylcholine (ACh) and sodium nitroprusside (NP). We also measured the forearm balance of nitrite and cyclic guanosine monophosphate (cGMP) before and during ACh infusion. Maximal oxygen uptake (VO₂max) was measured by breath-to-breath respiratory gas analysis.

RESULTS: Before treatment, the response of FBF to ACh was flat (p = NS). Growth hormone, but not placebo, greatly improved this response (p = 0.03) and, concomitantly, increased the forearm release of nitrite and cGMP (p < 0.05). Growth hormone also potentiated the FBF response to NP (p = 0.013). Growth hormone interacted with ACh response (p = 0.01) but not with the response to NP (p = NS). Accordingly, GH enhanced the slope of the dose-response curve to ACh (p < 0.05) but not to NP. The VO₂max increased significantly after GH treatment (20 ± 2 and 26 ± 2 ml ·Kg^–1· min^–1 before and after GH treatment, respectively, p < 0.05) but not after placebo.

CONCLUSIONS: A three-month treatment with GH corrected endothelial dysfunction and improved non-endothelium-dependent vasodilation in patients with CHF. The data highlight the potential role of GH in the progression of congestive heart failure.

Abbreviations and Acronyms   ACh   acetylcholine   cGMP   cyclic guanosine monophosphate   CHF   chronic heart failure   FBF   forearm blood flow   GH   growth hormone   IGF-I   insulin-like growth factor I   L-NMMA   L-N-monomethylarginine   LV   left ventricular   NYHA   New York Heart Association   NO   nitric oxide   NP   sodium nitroprusside   PVR   peripheral vascular resistance   VO2max   maximal oxygen uptake

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