Growth hormone and insulin-like growth factor-1 in acute myocardial infarction

Background Growth hormone therapy after myocardial infarction improves cardiac function and survival in animals. Beneficial effects in humans are reported from studies where patients with idiopathic dilated cardiomyopathy were treated with growth hormone. We have studied the role of the endogenous growth hormone system in myocardial infarction. Methods and Results Fifty-two consecutive patients with acute myocardial infarction were studied during the first 5 days and at follow-up 6 and 12 weeks later. The time from chest pain onset was used in the analyses. The mean growth hormone level within the first 6 h was nearly three times higher (1.1 +/- 0.2 mu g . l(-1)) than on the third day (0.4 +/- 0.05 mu g . l(-1), P<0.0002). It remained higher in patients with higher levels of cardiac enzymes, impaired left ventricular function and intense inflammatory response. Insulin-like growth factor-1 (IGF-1) declined slowly but remained within the normal range throughout the whole study period. Patients who died within 2 years had higher levels of growth hormone and lower levels of IGF-1, indicating growth hormone resistance. Endogenous levels of growth hormone or IGF-1 did not correlate with improvement in left ventricular function at 6 weeks. Conclusions The growth hormone axis is stimulated early in acute myocardial infarction, particularly in patients with more severe cardiac damage. Whether treatment with growth hormone can be beneficial for patients with heart failure after myocardial infarction remains to be investigated. (Eur Heart J 2000; 21: 1547-1554) (C) 2000 The European Society of Cardiology.