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Background: End-stage heart failure with idiopathic dilated cardiomyopathy (DCM) has no therapeutic options other than heart transplantation. We investigated whether exogenous insulin-like growth factor-1 (IGF-1) could improve cardiac function and symptoms in end-stage DCM patients on the waiting list for heart transplantation. Methods and Results: Recombinant IGF-1 was administered daily for three months to consecutive eight heart-transplant candidates with end-stage DCM. Cardiac catheterization, myocardial biopsy, echocardiography, magnetic resonance imaging, exercise test and neurohumoral blood samplings were conducted at baseline, at the end of three-month subcutaneous IGF-1 treatment and at the three-month follow-up. Ventricular mass index (91 ± 22 to 99 ± 27g/m2, p=0.003) and ejection fraction (18 ± 8 to 23 ± 7%, p=0.016) were increased at the end of treatment, and returned to baseline at the follow-up. However, New York Heart Association functional class (3.4 ± 0.5 to 2.3 ± 0.5, p=0.012) and brain natriuretic peptide (304 ± 264 to 150 ± 168 pg/mL, p=0.012) were improved at the end of treatment, and remained improved (2.1 ± 0.4, 166 ± 131 pg/mL, respectively) even at the follow-up. After treatment, a left ventricular assist device was removed from one patient. Two patients were withdrawn from the waiting list for heart transplantation. Conclusions: A three-month administration of recombinant IGF-1 to the patients on the waiting list with end-stage DCM might result in improvement in cardiac function and symptoms. IGF-1 therapy might be a novel treatment for bridge to transplant or recovery.

european heart journal

P1105Recombinant insulin-like growth factor-1 improves cardiac function and symptoms in the patients on the waiting list for heart transplantation with end-stage dilated cardiomyopathy