Deficient insulin-like growth factor I in chronic heart failure predicts altered body composition, anabolic deficiency, cytokine and neurohormonal activation

Item Type:	Article
Title:	Deficient insulin-like growth factor I in chronic heart failure predicts altered body composition, anabolic deficiency, cytokine and neurohormonal activation
Creators Name:	Niebauer, J. and Pflaum, C.D. and Clark, A.L. and Strasburger, C.J. and Hooper, J. and Poole-Wilson, P.A. and Coats, A.J. and Anker, S.D.
Abstract:	BACKGROUND: Recent studies of growth hormone supplementation in chronic heart failure have been associated with variable results. Acquired abnormalities of biochemical parameters of the growth hormone insulin-like growth factor I axis have been associated with severe chronic heart failure. There are suggestions of an acquired growth hormone resistance with deficient insulin-like growth factor I in some patients. OBJECTIVES: Therefore, we set out to investigate the clinical and functional status and the degree of cytokine and neurohormonal alteration of chronic heart failure patients with deficient insulin-like growth factor I responses. METHODS: Patients with chronic heart failure were divided into two groups according to their insulin-like growth factor I levels (classified according to the manufacturer's assay range in normal controls): low insulin-like growth factor I <104 (n = 20; 89 +/- 9.6 ng/ml), and normal/high >104 ng/ml (n = 32; 169 +/- 52 ng/ml). Between groups there was no difference in age (low versus high: 65.3 +/- 12.1 versus 61.6 +/- 9.1 years, p = 0.21), body mass index, aerobic capacity (peak oxygen consumption: low versus high: 15.5 +/- 5.2 versus 17.3 +/- 6.3 mL/kg/min, p = 0.23), left ventricular ejection fraction, New York Heart Association classification. RESULTS: During quadriceps strength testing, patients with low insulin-like growth factor I had reduced absolute strength (-24%), and strength per unit area muscle (- 14%) than patients with normal/high insulin-like growth factor I. Leg muscle cross-sectional area was lower in the low insulin-like growth factor I group (-12% and -13% for right and left legs, respectively). These alterations were accompanied by increased levels of growth hormone (+145%), tumor necrosis factor-alpha (+46%), cortisol/ dehydroepiandrosterone ratio (+60%), noradrenaline (+49%) and adrenaline (+136%) (all at least p < 0.05). CONCLUSIONS: Patients with low insulin-like growth factor I levels show signs of altered body composition, cytokine and neuroendocrine activation, to a greater extent than patients with normal/high levels.
Keywords:	Adrenergic alpha-Agonists, Age Factors, Body Composition, Body Mass Index, Cross-Sectional Anatomy, Cytokines, Dehydroepiandrosterone, Drug Resistance, Energy Metabolism, Epinephrine, Heart Failure, Human Growth Hormone, Hydrocortisone, Insulin-Like Growth Factor I, Left Ventricular Function, Leg, Muscle Contraction, Neuropeptides, Norepinephrine, Oxygen Consumption, Skeletal Muscle, Stroke Volume, Tumor Necrosis Factor-alpha
Source:	Journal of the American College of Cardiology
ISSN:	0735-1097
Publisher:	Elsevier
Volume:	32
Number:	2
Page Range:	393-397
Date:	August 1998
Official Publication:	https://doi.org/10.1016/S0735-1097(98)00226-5
PubMed:	View item in PubMed

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