Treatment of the lOw IGF-1 Syndrome aSsociated With Chronic Heart fAilure: A Randomized, Placebo-Controlled, Double-Blind Study.

Inclusion Criteria: * patients of either sex affected by CHF NYHA class II-III, secondary to ischemic or idiopathic dilated cardiomyopathy * age range 30-80 years * stable medications for at least two months prior to randomization, including ACE inhibitors or AT1 antagonists and beta-blockers (unless untolerated). * LV ejection fraction 40% or less * Peak VO2 consumption during a CPET ≤ 16 ml/kg/min. * LV end-diastolic dimension 55 mm or more * low IGF-1 levels and a satisfactory response to an IGF-1 generation test * informed consent Exclusion Criteria: * haemodynamic clinically significant primary valvular disease or significant congenital heart disease * acute pericarditis/myocarditis * inability to perform a bicycle exercise test * Poorly controlled diabetes mellitus (HbA1c \>8.5) * active proliferative or severe non-proliferative diabetic retinopathy * active and/or history of malignancy * evidence of progression or recurrence of an underlying intracranial tumor * unstable angina or recent myocardial infarction (less than 5 months) * severe liver disease * serum creatinine levels \>2.5 mg/dl * Inability to cooperate or administer the study drug * Patients participating in any other clinical study, within 30 days prior to screening visit and/or during this particular study period