Growth hormone for optimization of refractory heart failure treatment

Abstract

It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-yearold man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine) 13.4 and to 16.2ml/kg/min later). The patient was "de-listed" for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure.Heart failure remains a high mortality and morbidity syndrome despite advances in management 1 . Besides its relative effectiveness, the clinical use of conventional or newer drugs is sometimes limited by clinical status of the patient, pharmacological intolerance or because the drug is under investigation 2 . The use of surgical procedures, such as heart transplantation, cardiomyoplasty, partial left ventriculectomy and cardiac pacemakers, is limited by donor scarcity, rigid selection criteria, graft degeneration or by lack of knowledge of accurate criteria to select patients who have chance of benefiting from a given modality of treatment 1,3,4 . Among neurohormonal changes in congestive heart failure, fall or elevation in growth hormone levels and changes in IGF-1 (somatomedin C) hormonal axis have been described, with inappropriate (low/normal) IGF-1 level in relation to growth hormone level [5][6][7][8] . Growth hormone has a widespread metabolic effect and influences the control of heart stress and performance, through activation of somatomedins, especially IGF-1 6 . It has been suggested that resistance to growth hormone might occur in heart failure 9 . It was proposed that growth hormone might be useful in patients with heart failure, and the purpose of this report is to describe its effect optimizing the therapy of refractory heart failure, in a patient receiving intravenous inotropic drugs. Case reportA 63-year-old white man, referred to heart transplantation due to refractory heart failure, was admitted into the hospital in July 23, 1998. He had suffered an acute myocardial infarction in 1988 and underwent coronary artery bypass surgery in October 1988. He had already been submitted to prostatectomy in July 10, 1997, due to prostate adenocarcinoma. He had been asymptomatic until January 1998, when he began to complain of exertional dyspnea. Coronary arteriography was performed in April 09, 1998 and showed total occlusion of both left anterior descending and left circumflex arteries, a proximal 70 % stenosis of a left marginal branch, a severe proximal stenosis of the right coronary artery, total ostial occlusion of two saphenous vein grafts (from the aorta to a marginal branch and from the aorta to the right coronary artery) and another saphenous vein graft, to the anterior descending artery, free of significant narrowing, with a satisfactory aspect. The patient underwent a successful percutaneous transluminal coronary angioplasty of the right coronary artery with stent implantation, but his symptoms did not improve. Laboratory evaluation showed total cholesterol of 154 mg/dl, HDL-cholesterol of 51 mg/d...

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

“…Preliminary results of the administration of GH in cachectic patients seem to determine some clinical improvement and optimization of the treatment 105 ; however, randomized studies are necessary to assess its real effect 106,107 . It must be used with caution in patients at risk for cancer or with arrhythmias.…”

Efeito do treinamento físico nos marcadores inflamatórios em pacientes com insuficiência cardíaca

“…Esta inversão ocorre inicialmente nos segmentos basais, sendo que a presença de uma alteração regional diastólica em mais de 50% de segmentos miocárdicos está associada a uma relação E/A< 1 ao (1992, SOLVD) , enquanto nos pacientes gravemente incapacitados, onde observa-se mortalidade de 50% em um ano, observamos uma grande intolerância aos esforços. (Bocchi, Massuda et al 1999). Nas últimas duas décadas, um grande número de estudos tem surgido, descrevendo o benefício de um programa de atividade física em indivíduos com IC.…”