Growth hormone therapy in heart failure.

Clinical and experimental data in animals and patients with endstage heart failure due to dilated cardiomyopathy or ischemic heart disease suggest a beneficial role of growth factors like human recombinant growth hormone or insulin-like growth factor I. Their cardiac effects are an increase in myocardial mass and a decrease in systolic wall stress. Based on the results of animal studies and of preliminary studies in patients with dilated cardiomyopathy, double-blind and placebo-controlled studies have proven the increase in myocardial mass and a significant reduction of left ventricular wall stress, as demonstrated by magnetic resonance imaging.The risk of the additional therapy with human growth factors in this high-risk group of patients with a high mortality is justified, if this new approach becomes a possible alternative to cardiac transplantation or a bridge toward transplantation.If future randomized studies in larger patient groups with an individualized substitution therapy with growth hormone and/or IGF-I can demonstrate a beneficial effect on mortality and morbidity, this new therapeutic approach could become an attractive alternative in these high-risk patients.