CLINICAL RESEARCH: HEART FAILURE
Increased Level of Pericardial Insulin-Like Growth Factor-1 in Patients With Left Ventricular Dysfunction and Advanced Heart Failure
Naoki Abe, MD*,
Toshiro Matsunaga, MD*,
Kunihiko Kameda, MD*,
Hirofumi Tomita, MD*,
Takayuki Fujiwara, MD*,
Hiroshi Ishizaka, MD*,
Hiroyuki Hanada, MD*,
Kozo Fukui, MD ,
Ikuo Fukuda, MD ,
Tomohiro Osanai, MD* and
Ken Okumura, MD*,*
* Second Department of Internal Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
First Department of Surgery, Hirosaki University School of Medicine, Hirosaki, Japan.
Manuscript received February 6, 2006;
revised manuscript received June 6, 2006,
accepted June 12, 2006.
* Reprint requests and correspondence: Dr. Ken Okumura, Second Department of Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki 0368562, Japan. (Email: okumura{at}cc.hirosaki-u.ac.jp).
OBJECTIVES: To test the hypothesis that the cardiac insulin-like growth factor-1 (IGF-1) system is up-regulated in the failing heart, we measured the pericardial (cardiac) and plasma (circulating) IGF-1 levels in coronary artery disease patients.
BACKGROUND: Local IGF-1 systems are regulated differently from the systemic IGF-1 system. The cardiac IGF-1 system is up-regulated by the increased left ventricular (LV) wall stress. However, it remains unknown how this system is affected in LV dysfunction and heart failure.
METHODS: We measured the plasma and pericardial fluid levels of IGF-1 and brain natriuretic peptide (BNP) in 87 coronary artery disease patients undergoing cardiac surgery, and examined their relationships with LV function and heart failure severity. The expressions of IGF-1 and IGF-1 receptor proteins were examined in endomyocardial biopsies obtained from other patients with normal or impaired LV function.
RESULTS: The pericardial IGF-1 and BNP levels were positively correlated with the plasma BNP level (both p < 0.001). The pericardial IGF-1 level was increased in heart failure patients, whereas the plasma IGF-1 level was rather decreased. The pericardial IGF-1 level was inversely correlated with the LV ejection fraction (p < 0.001), whereas the plasma IGF-1 level was not. Positive immunostaining for IGF-1 and IGF-1 receptor proteins was enhanced in myocardial biopsies from failing hearts compared with those from nonfailing hearts.
CONCLUSIONS: The pericardial IGF-1 level was increased in patients with LV dysfunction and heart failure, whereas the plasma IGF-1 level was decreased. These results may indicate that up-regulation of the cardiac IGF-1 system serves as a compensatory mechanism for LV dysfunction.
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Abbreviations and Acronyms
| | ANOVA = analysis of variance | | BNP = brain natriuretic peptide | | CABG = coronary artery bypass graft surgery | | CAD = coronary artery disease | | IGF-1 = insulin-like growth factor-1 | | IGFBP = insulin-like growth factor binding protein | | LVEF = left ventricular ejection fraction | | LVG = left ventriculography | | NYHA = New York Heart Association |
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