9
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Análise das alterações cardiovasculares em adultos com deficiência de hormônio de crescimento através da dopplerecocardiografia e do teste de esforço cardiopulmonar

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          A síndrome de deficiência de hormônio do crescimento (GHD) no adulto está bem estabelecida, assim como os benefícios da terapia com reposição de hormônio de crescimento (GH). Dentre os aspectos mais estudados observam-se as alterações cardiovasculares. Tem sido descrito aumento de mortalidade, maior incidência de aterosclerose e alterações da função cardíaca. Através da análise da função cardíaca sistólica e diastólica pela dopplerecocardiografia e do comportamento no teste de esforço cardiopulmonar, foram avaliadas as alterações cardiovasculares em 26 pacientes com GHD, sendo 4 com deficiêrncia desde a infância (cGHD) e 22 com déficit adquirido na vida adulta (aGHD). Notou-se alteração da função cardíaca diastólica em 2 pacientes (7,7%), sem alterações na função sistólica e em 3 pacientes observou-se redução dos valores de stress sistólico do ventrículo esquerdo. Em 1 paciente havia redução da massa ventricular indexada pela superfície corporal. Na análise do teste de esforço observou-se diminuição (VO2/FC) em 69% dos indivíduos. Conclui-se que adultos com GHD têm capacidade funcional reduzida e disfunção cardíaca sistólica incipiente. A avaliação em repouso pela Dopplerecocardiografia não demonstrou alterações expressivas nesta população.

          Translated abstract

          The growth hormone deficiency syndrome in adults (GHD) is well established, as well as the benefits of replacement with recombinant growth hormone (GH). Cardiovascular disease is one of the most studied aspects of this syndrome. Increased mortality, higher incidence of atherosclerosis and impairment in heart performance has been reported. Cardiovascular alterations were sought for in 26 GHD patients: 4 of them had the deficiency since childhood (cGHD) and 22 had acquired GHD in adult life (aGHD). The study was done by analyzing the systolic and diastolic cardiac function by two-dimensional (2-D) Dopplerechocardiographic study and by performance noted on cardiopulmonary effort test. Diastolic dysfunction was noted in 2 patients (7.7%) - without systolic alterations - and reduced left ventricle systolic stress in 3 patients. Reduced left ventricle mass index was present in one patient with cGHD. The effort test results showed reduction of exercise capacity (maximum VO2 achieved) in 92% of patients and reduced inotropic response represented by oxygen pulse (VO2/heart rate) in 69%. We concluded that adults with GHD have reduced functional capacity and incipient systolic cardiac dysfunction. The 2-D dopplerechocardiographic evaluation at rest showed no significant alterations in this population.

          Related collections

          Most cited references46

          • Record: found
          • Abstract: found
          • Article: not found

          Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.

          To determine the accuracy of echocardiographic left ventricular (LV) dimension and mass measurements for detection and quantification of LV hypertrophy, results of blindly read antemortem echocardiograms were compared with LV mass measurements made at necropsy in 55 patients. LV mass was calculated using M-mode LV measurements by Penn and American Society of Echocardiography (ASE) conventions and cube function and volume correction formulas in 52 patients. Penn-cube LV mass correlated closely with necropsy LV mass (r = 0.92, p less than 0.001) and overestimated it by only 6%; sensitivity in 18 patients with LV hypertrophy (necropsy LV mass more than 215 g) was 100% (18 of 18 patients) and specificity was 86% (29 of 34 patients). ASE-cube LV mass correlated similarly to necropsy LV mass (r = 0.90, p less than 0.001), but systematically overestimated it (by a mean of 25%); the overestimation could be corrected by the equation: LV mass = 0.80 (ASE-cube LV mass) + 0.6 g. Use of ASE measurements in the volume correction formula systematically underestimated necropsy LV mass (by a mean of 30%). In a subset of 9 patients, 3 of whom had technically inadequate M-mode echocardiograms, 2-dimensional echocardiographic (echo) LV mass by 2 methods was also significantly related to necropsy LV mass (r = 0.68, p less than 0.05 and r = 0.82, p less than 0.01). Among other indexes of LV anatomy, only measurement of myocardial cross-sectional area was acceptably accurate for quantitation of LV mass (r = 0.80, p less than 0.001) or diagnosis of LV hypertrophy (sensitivity = 72%, specificity = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements.

            Four hundred M-mode echocardiographic surveys were distributed to determine interobserver variability in M-mode echocardiographic measurements. This was done with a view toward examining the need and determining the criteria for standardization of measurement. Each survey consisted of five M-mode echocardiograms with a calibration marker, measured by the survey participants anonymously. The echoes were judged of adequate quality for measurement of structures. Seventy-six of the 400 (19%) were returned, allowing comparison of interobserver variability as well as examination of the measurement criteria which were used. Mean measurements and percent uncertainty were derived for each structure for each criterion of measurement. For example, for the aorta, 33% of examiners measured the aorta as an outer/inner or leading edge dimension, and 20% measured it as an outer/outer dimension. The percent uncertainty for the measurement (1.97 SD divided by the mean) showed a mean of 13.8% for the 25 packets of five echoes measured using the former criteria and 24.2% using the latter criteria. For ventricular chamber and cavity measurements, almost one-half of the examiners used the peak of the QRS and one-half of the examiners used the onset of the QRS for determining end-diastole. Estimates of the percent of measurement uncertainty for the septum, posterior wall and left ventricular cavity dimension in this study were 10--25%. They were much higher (40--70%) for the right ventricular cavity and right ventricular anterior wall. The survey shows significant interobserver and interlaboratory variation in measurement when examining the same echoes and indicates a need for ongoing education, quality control and standardization of measurement criteria. Recommendations for new criteria for measurement of M-mode echocardiograms are offered.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency.

              In a double-blind, placebo-controlled trial, we studied the effects of six months of growth hormone replacement in 24 adults with growth hormone deficiency. Most of the patients had acquired growth hormone deficiency during adulthood as a consequence of treatment for pituitary tumors, and all were receiving appropriate thyroid, adrenal, and gonadal hormone replacement. The daily dose of recombinant human growth hormone (rhGH) was 0.07 U per kilogram of body weight, given subcutaneously at bedtime. The mean (+/- SE) plasma concentration of insulin-like growth factor I increased from 0.41 +/- 0.05 to 1.53 +/- 0.16 U per liter during rhGH treatment. Treatment with rhGH had no effect on body weight. The mean lean body mass, however, increased by 5.5 +/- 1.1 kg (P less than 0.0001), and the fat mass decreased by 5.7 +/- 0.9 kg (P less than 0.0001) in the group treated with growth hormone; neither changed significantly in the placebo group. The basal metabolic rate, measured at base line and after one and six months of rhGH administration, increased significantly; the respective values were 32.4 +/- 1.4, 37.2 +/- 2.2, and 34.4 +/- 1.6 kcal per kilogram of lean body mass per day (P less than 0.001 for both comparisons). Fasting plasma cholesterol levels were lower (P less than 0.05) in the rhGH-treated group than in the placebo group, whereas plasma triglyceride values were similar in the two groups throughout the study. We conclude that growth hormone has a role in the regulation of body composition in adults, probably through its anabolic and lipolytic actions.
                Bookmark

                Author and article information

                Journal
                abem
                Arquivos Brasileiros de Endocrinologia & Metabologia
                Arq Bras Endocrinol Metab
                Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo, SP, Brazil )
                1677-9487
                December 2001
                : 45
                : 6
                : 540-546
                Affiliations
                [02] RJ orgnameUniversidade Federal do Rio de Janeiro orgdiv1Hospital Universitário Clementino Braga Filho orgdiv2Serviço de Cardiologia
                [01] orgnameUniversidade Federal do Rio de Janeiro orgdiv1Hospital Universitário Clementino Braga Filho orgdiv2Serviço de Endocrinologia
                Article
                S0004-27302001000600006 S0004-2730(01)04500606
                10.1590/S0004-27302001000600006
                60cf1401-2cad-450d-a146-651623125225

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 01 April 2001
                : 16 April 2001
                : 18 August 2000
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 46, Pages: 7
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                GH deficiency,Dopplerechocardiography,Cardiopulmonary effort test,Déficit de GH,Alterações cardiovasculares,Dopplerecocardiografia,Teste de esforço cardiopulmonar,Cardiovascular disease

                Comments

                Comment on this article