GH1 and cardiac hypertrophy: In conclusion, based on present and previous findings, we suggest that elevated levels of asymmetric dimethyl-arginine (ADMA) in the pericardial fluid of cardiac patients could indicate important pathophysiological mechanisms, such as absolute or relative cardiac ischemia and hypoxia leading to reduced bioavailability of nitric oxide, which–together with the locally released growth hormone Ang II—can contribute to the development of cardiac hypertrophy and remodeling (Fig 5).