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Growth hormone therapy in congestive heart failure due to left ventricular systolic dysfunction: a meta-analysis.

Research paper by Nicholas A NA Tritos, Peter G PG Danias

Indexed on: 02 Feb '08Published on: 02 Feb '08Published in: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists



Abstract

To examine the efficacy and safety of recombinant human growth hormone (rhGH) therapy in congestive heart failure (CHF) by conducting a meta-analysis of clinical studies.We searched 3 literature databases (MEDLINE, EMBASE, and the Cochrane Register) for clinical studies of rhGH therapy in CHF due to systolic dysfunction and conducted a meta-analysis.Therapy with rhGH appears to have beneficial clinical effects (weighted mean difference [95% confidence interval]) in CHF including improved exercise duration (1.9 min [1.1-2.7]), maximum oxygen consumption (2.1 mL x kg(-1) x min(-1) [1.2-3.0]), and New York Heart Association class (-0.9 [-1.5 to -0.3]). There were salutary hemodynamic effects of rhGH therapy, including increased cardiac output (0.4 L x min(-1) [0.1-0.6]) and decreased systemic vascular resistance (-177 dyn x s x cm(-5) [-279 to -74]). Among rhGH-treated patients, left ventricular (LV) ejection fraction improved (4.3% [2.2-6.4]). Despite increases in LV mass and wall thickness, there were no adverse effects on diastolic function. Subgroup analyses suggest that study design and treatment duration may influence some of the treatment effects. Most of the beneficial effects were driven by either uncontrolled or longer duration studies. Administration of rhGH therapy slightly increased the risk for ventricular arrhythmia; however, this finding was driven by a single small study.rhGH therapy may have beneficial cardiovascular effects in CHF caused by LV systolic dysfunction. The possibility of proarrhythmia associated with rhGH therapy requires further study. Larger randomized trials with longer treatment duration are needed to fully elucidate the efficacy and safety of rhGH therapy in this patient population.