Growth hormone therapy in cardiac conditions: Implications for heart failure, congenital Acyanotic and cyanotic heart disease, and tetralogy of Fallot

Background: Growth hormone (GH) therapy has been widely used in pediatric endocrinology to treat short stature and metabolic disorders. However, its application in children with congenital heart disease (CHD) and congestive heart failure (CHF) remains controversial due to concerns about its effects on cardiac function.

Objective: This review evaluates the impact of GH therapy on growth parameters, metabolic health, and cardiac function in children with acyanotic and cyanotic CHD, Tetralogy of Fallot (ToF), and CHF.

Methods: A comprehensive literature review was conducted on 20 studies assessing GH therapy in pediatric patients with cardiac conditions, including a total of 2,350 subjects. Key outcomes analyzed included growth velocity, IGF-1 levels, left ventricular ejection fraction (LVEF), cardiac stability, and metabolic changes. Key outcomes analyzed included growth velocity, IGF-1 levels, left ventricular ejection fraction (LVEF), cardiac stability, and metabolic changes.

Results: Studies indicate that GH therapy significantly improves growth velocity, IGF-1 levels, and height-for-age z-scores in children with acyanotic CHD, with minimal adverse cardiac effects. Nutritional interventions further enhance growth outcomes. In cyanotic CHD, GH therapy is effective in promoting growth, but chronic hypoxemia may affect its efficacy. Surgical correction of cyanotic defects contributes to post-intervention growth recovery. In ToF, GH therapy leads to notable growth velocity improvements and stable cardiac function, with transient metabolic side effects reported in a minority of patients. In CHF, GH therapy improves growth, and in some cases, cardiac function, including LVEF and endothelial health. However, results on cardiac benefits are inconsistent, with some studies showing no significant improvement in heart failure patients without GH deficiency.

Conclusion: GH therapy is effective in promoting growth in pediatric cardiac patients and may offer additional metabolic and endothelial benefits. However, its impact on cardiac function varies, necessitating careful patient selection and monitoring. Long-term cardiovascular safety remains a key concern, particularly in patients with preexisting myocardial abnormalities. Future research should focus on optimizing GH dosing strategies, refining patient selection criteria, and conducting long-term follow-up studies to ensure the safety and efficacy of GH therapy in this population.