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J Am Coll Cardiol, 2006; 48:1387-1395, doi:10.1016/j.jacc.2006.06.048 (Published online 11 September 2006).
© 2006 by the American College of Cardiology Foundation
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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{dagger}, Ikuo Fukuda, MD{dagger}, Tomohiro Osanai, MD* and Ken Okumura, MD*,*

* Second Department of Internal Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
{dagger} 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.

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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