GH Therapy in Chronic Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT: Guideline-directed medical therapy of heart failure (HF) primarily targets neurohormonal activation. However, GH has emerged as a potential treatment for the multiple hormonal deficiency syndrome, which is associated with worse outcomes in HF. OBJECTIVE: This study evaluates the efficacy and safety of GH therapy in HF. DATA SOURCES: A systematic search was conducted in PubMed, Cochrane Library, and ClinicalTrials.gov, according to PRISMA guidelines. STUDY SELECTION: Randomized, placebo-controlled trials studying GH therapy in adult HF patients were included. Of the 1184 initially identified records, 17 studies (1.4%) met the inclusion criteria. DATA EXTRACTION: Two independent authors conducted the search, with any disagreements resolved by a third author. Study quality was assessed using predefined criteria, including randomization, blinding, and the presence of a placebo group. DATA SYNTHESIS: A random-effects model was applied due to heterogeneity across studies. GH therapy significantly improved left ventricular ejection fraction (+3.34%; 95% CI, 1.09-5.59; P = .0037), peak oxygen consumption (+2.84 mL/kg/min; 95% CI, 1.32-4.36; P = .0002), and New York Heart Association class (-0.44; 95% CI, -0.08 to -0.81; P = .023). GH therapy also reduced the composite of death, worsening HF or ventricular tachycardia by 41% (RR = .59; 95% CI, 0.39-0.90; P = .013). Subgroup analyses indicated that patients with ischemic cardiomyopathy, baseline ejection fraction ≥30%, and longer treatment duration experienced greater benefits. CONCLUSION: GH therapy demonstrated improvements in cardiac function, exercise capacity, and HF symptoms, along with a statistically significant trend toward improvements in hard endpoints. Event-driven trials are needed to validate these findings.