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. 2006 Feb 28:6:1.
doi: 10.1186/1472-6823-6-1.

Echocardiographic assessment of subclinical left ventricular eccentric hypertrophy in adult-onset GHD patients by geometric remodeling: an observational case-control study

Cesare de Gregorio  1 , Lorenzo Curtò, Antonino Recupero, Patrizia Grimaldi, Barbara Almoto, Marilena Venturino, Domenico Cento, Maria Carola Narbone, Francesco Trimarchi, Sebastiano Coglitore, Salvatore Cannavò
Affiliations

Echocardiographic assessment of subclinical left ventricular eccentric hypertrophy in adult-onset GHD patients by geometric remodeling: an observational case-control study

Cesare de Gregorio et al. BMC Endocr Disord. .

Abstract

Background: Most patients with growth hormone deficiency (GHD) show high body mass index. Overweight subjects, but GHD patients, were demonstrated to have high left ventricular mass index (LVMi) and abnormal LV geometric remodeling. We sought to study these characteristics in a group of GHD patients, in an attempt to establish the BMI-independent role of GHD.

Methods: Fifty-four patients, 28 F and 26 M, aged 45.9 +/- 13.1, with adult-onset GHD (pituitary adenomas 48.2%, empty sella 27.8%, pituitary inflammation 5.5%, cranio-pharyngioma 3.7%, not identified pathogenesis 14.8%) were enrolled. To minimize any possible interferences of BMI on the aim of this study, the control group included 20 age- and weight-matched healthy subjects. The LV geometry was identified by the relationship between LVMi (cut-off 125 g/m2) and relative wall thickness (cut-off 0.45) at echocardiography.

Results: There was no significant between-group difference in resting cardiac morphology and function, nor when considering age-related discrepancy. The majority of patients had normal-low LVM/LVMi, but about one fourth of them showed higher values. These findings correlated to relatively high circulating IGF-1 and systolic blood pressure at rest. The main LV geometric pattern was eccentric hypertrophy in 22% of GHD population (26% of with severe GHD) and in 15% of controls (p = NS).

Conclusion: Though the lack of significant differences in resting LV morphology and function, about 25% of GHD patients showed high LVMi (consisting of eccentric hypertrophy), not dissimilarly to overweight controls. This finding, which prognostic role is well known in obese and hypertensive patients, is worthy to be investigated in GHD patients through wider controlled trials.

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Figures

Figure 1
Figure 1
Prevalence of left ventricular mass and left ventricular mass index in the study population. LEGEND:m-GHD, patients with mild GHD; s-GHD, patients with severe GHD.
Figure 2
Figure 2
Age-related differences in left ventricular mass index (LVMi), relative wall thickening (RWT), mitral E/A velocity ratio (E/A ratio), left ventricular ejection fraction (LVEF), endocardial fractional shortening (EFS), and midwall fractional shortening (MFS), in the GHD population (n = 54).
Figure 3
Figure 3
Scatter plot illustrating the left ventricular remodeling in severe (open circles), partial (full circles) GHD and controls (squares). Numbers and percents (%) of the cases in each group are displayed in the table underneath. Legends: CR, concentric remodeling; CH, concentric hypertrophy; EH, eccentric hypertrophy; LVMi, left ventricular mass index; RWT, relative wall thickness.
Figure 4
Figure 4
Linear relationship between circulating IGF-1 and left ventricular mass index (LVMi) in patients with mild (open circles) and severe (full circles) GHD. Correlation r-values and p-values in both groups and in patients with severe GHD are reported.
See this image and copyright information in PMC

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