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Sangali TD, Souza GC, Ribeiro ÉCT, Perry IDS. Sarcopenia: Inflammatory and Humoral Markers in Older Heart Failure Patients. Arq Bras Cardiol 2023; 120:e20220369. [PMID: 37556651 PMCID: PMC10382140 DOI: 10.36660/abc.20220369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/02/2023] [Accepted: 04/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Sarcopenia is highly prevalent in heart failure (HF) patients, and the involvement of biomarkers in its pathophysiology is suggested, but little has been studied concerning HF sarcopenic patients. OBJECTIVES To evaluate the association between inflammatory and humoral markers with sarcopenia, as well as the impact of sarcopenia on quality of life and functional capacity in older HF patients. METHODS In this cross-sectional study, 90 outpatient HF patients, aged ≥ 60 years, were evaluated for sarcopenia (EWGSOP2 diagnostic criteria), inflammation (high-sensitive C-reactive protein [hs-CRP], Interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-α]) and humoral markers (total testosterone and insulin-like growth factor-1 [IGF-1]), physical activity (International Physical Activity Questionnaire), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walk test). The adopted level of significance was p<0.05. RESULTS Patients had a mean age of 69.4 ± 7.2 years, 67.8% were male, with left ventricular ejection fraction (LVEF) of 35.9 ± 11.9% and 22 (24.4%) were sarcopenic. Age (73.1 ± 8.1 and 68.3 ± 6.5 years; p= 0.006), body mass index (BMI) (23.1 ± 2.8 and 28.2 ± 4.2 kg/m2; p <0.001), and LVEF (29.9 ± 8.8 and 37.9 ± 12.1%; p= 0.005) were different between groups with and without sarcopenia, respectively. After adjusting for age, ethnicity, BMI, LVEF, and the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, sarcopenia was associated with higher serum levels of IL-6 and worse functional capacity. CONCLUSION In HF patients, sarcopenia was associated with IL-6 levels and functional capacity.
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Affiliation(s)
- Tamirys Delazeri Sangali
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Gabriela Corrêa Souza
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
| | - Édina Caroline Ternus Ribeiro
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
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Damluji AA, Alfaraidhy M, AlHajri N, Rohant NN, Kumar M, Al Malouf C, Bahrainy S, Ji Kwak M, Batchelor WB, Forman DE, Rich MW, Kirkpatrick J, Krishnaswami A, Alexander KP, Gerstenblith G, Cawthon P, deFilippi CR, Goyal P. Sarcopenia and Cardiovascular Diseases. Circulation 2023; 147:1534-1553. [PMID: 37186680 PMCID: PMC10180053 DOI: 10.1161/circulationaha.123.064071] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Maha Alfaraidhy
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Noora AlHajri
- Cleveland Clinic, Abu Dhabi, United Arab Emirates (N.A.)
| | | | | | | | | | | | - Wayne B Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Daniel E Forman
- University of Pittsburgh and the Pittsburgh Geriatric Research Education and Clinical Center, PA (D.E.F.)
| | | | | | | | - Karen P Alexander
- Duke Clinical Research Institute, Duke University, Durham, NC (K.P.A.)
| | - Gary Gerstenblith
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | | | - Christopher R deFilippi
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Parag Goyal
- University of Arizona, Tucson (N.N.R., P.G.)
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3
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Impact of Hormonal-Anabolic Deficiencies in Idiopathic Pulmonary Arterial Hypertension. Heart Fail Clin 2023; 19:115-123. [DOI: 10.1016/j.hfc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Marra AM, D'Assante R, Salzano A, Iacoviello M, Triggiani V, Rengo G, Limongelli G, Masarone D, Perticone M, Cimellaro A, Perrone Filardi P, Paolillo S, Gargiulo P, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Arcopinto M, D'Agostino A, Raparelli V, Isidori AM, Valente V, Giardino F, Crisci G, Sciacqua A, Savoia M, Suzuki T, Bossone E, Cittadini A. Testosterone deficiency independently predicts mortality in women with HFrEF: insights from the T.O.S.CA. registry. ESC Heart Fail 2022; 10:159-166. [PMID: 36134448 PMCID: PMC9871710 DOI: 10.1002/ehf2.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS Testosterone deficiency (TD) is associated with increased morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). However, data in women are scanty. The aim of this study was to investigate the prognostic impact of TD on women with HFrEF. METHODS Among 480 patients prospectively enrolled in the T.O.S.CA. (Terapia Ormonale Scompenso CArdiaco) registry, a prospective, multicentre, nationwide, observational study, 94 women were included in the current analysis. The TD was defined as serum testosterone levels lower than 25 ng/dl. Data regarding clinical status, echocardiography, exercise performance, cardiovascular hospitalization, and survival after an average follow-up of 36 months were analysed. RESULTS Thirty patients (31.9%) displayed TD. TD was associated with lower tricuspid annular plane excursion (TAPSE) to pulmonary arterial systolic pressure PASP ratio (TAPSE/PASP) (P = 0.008), peak oxygen consumption (VO2 peak) (P = 0.03) and estimated glomerular filtration rate (P < 0.001). TD was an independent predictor of the combined endpoint of all-cause mortality/cardiovascular hospitalization (HR: 10.45; 95% CI: 3.54-17.01; P = 0.001), all-cause mortality (HR: 8.33; 95%: 5.36-15.11; P = 0.039), and cardiovascular hospitalization (HR: 2.41; 95% CI: 1.13-4.50; P = 0.02). CONCLUSIONS One-third of women with HFrEF displays TD that impacts remarkably on their morbidity and mortality. TD is associated with a worse clinical profile including exercise capacity, right ventricular-pulmonary arterial coupling, and renal function. These findings lend support to an accurate profiling of women with HF, a problem often overlooked in clinical trials.
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Affiliation(s)
- Alberto M. Marra
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly,Center for Pulmonary HypertensionThoraxclinic at Heidelberg University HospitalHeidelbergGermany
| | - Roberta D'Assante
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | | | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare DiseasesUniversity of Bari 'A Moro'BariItaly
| | - Giuseppe Rengo
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), IRCCSScientific Institute of Telese TermeTeleseItaly
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei ColliUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei ColliUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Maria Perticone
- Department of Experimental and Clinical MedicineUniversity Magna Græcia of CatanzaroCatanzaroItaly
| | - Antonio Cimellaro
- Department of Medical and Surgical SciencesUniversity Magna Græcia of CatanzaroCatanzaroItaly
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly,Mediterranea CardiocentroNaplesItaly
| | - Stefania Paolillo
- Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly,Mediterranea CardiocentroNaplesItaly
| | - Paola Gargiulo
- Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly
| | - Antonio Mancini
- Department of Medical SciencesIRCCS San Raffaele PisanaRomeItaly
| | | | - Olga Vriz
- Heart Center DepartmentKing Faisal Hospital & Research CenterRiyadhSaudi Arabia
| | - Roberto Castello
- Division of General MedicineAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | | | - Michela Campo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Metabolic DiseasesUniversity of FoggiaFoggiaItaly
| | - Pietro A. Modesti
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi di FirenzeFlorenceItaly
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and PreventionUniversity of FerraraFerraraItaly
| | - Michele Arcopinto
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly
| | | | - Valeria Raparelli
- Department of Translational MedicineUniversity of FerraraFerraraItaly,University Center for Studies on Gender MedicineUniversity of FerraraFerraraItaly,Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Valeria Valente
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Federica Giardino
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Giulia Crisci
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Angela Sciacqua
- Department of Medical and Surgical SciencesUniversity Magna Græcia of CatanzaroCatanzaroItaly
| | - Marcella Savoia
- Department of Molecular Medicine and Medical BiotechnologiesUniversity of Naples Federico IINaplesItaly
| | - Toru Suzuki
- Department of Cardiovascular SciencesUniversity of Leicester, NIHR Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly,Cardiology DivisionA Cardarelli HospitalNaplesItaly
| | - Antonio Cittadini
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly
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De Giorgi A, Marra AM, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Filardi PP, Paolillo S, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, Salzano A, D’Assante R, Arcopinto M, Raparelli V, Fabbian F, Sciacqua A, Colao A, Suzuki T, Bossone E, Cittadini A. Insulin-like growth factor-1 (IGF-1) as predictor of cardiovascular mortality in heart failure patients: data from the T.O.S.CA. registry. Intern Emerg Med 2022; 17:1651-1660. [PMID: 35445917 PMCID: PMC9463276 DOI: 10.1007/s11739-022-02980-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/23/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Data from the "Trattamento Ormonale nello Scompenso CArdiaco" (T.O.S.CA) registry showed that heart failure (HF) represents a complex clinical syndrome with different hormonal alterations. Renal failure represents a frequent complication in HF. We evaluated the relationship between renal function and insuline-like growth factor-1 (IGF-1) deficiency and its impact on cardiovascular mortality (CVM) in patients enrolled in the T.O.S.CA. registry. METHODS At the enrolment, all subjects underwent chemistry examinations, including circulating hormones and cardiovascular functional tests. COX regression analysis was used to evaluate factors related to CVM during the follow-up period in all populations, in high-risk patients and in the young-adult population. Also, we evaluate the effects of renal function on the CVM. RESULTS 337 patients (41 deceased) were analyzed. CVM was related to severe renal dysfunction (HR stages IV-V = 4.86), high-risk conditions (HR 2.25), serum IGF-1 (HR 0.42), and HF etiology (HR 5.85 and HR 1.63 for valvular and ischemic etiology, respectively). In high-risk patients, CVM was related to IGF-1 levels, severe renal dysfunction and valvular etiology, whereas in young patients CMV was related to the high-risk pattern and serum IGF-1 levels. CONCLUSIONS Our study showed the clinical and prognostic utility of the IGF-1 assay in patients with HF.
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Affiliation(s)
- Alfredo De Giorgi
- grid.416315.4Clinica Medica Unit, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
| | - Alberto Maria Marra
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- grid.5253.10000 0001 0328 4908Italian Clinical Outcome Research and Reporting Program (I-CORRP)-Center for Pulmonary Hypertension, Thorax Clinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Massimo Iacoviello
- grid.10796.390000000121049995Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vincenzo Triggiani
- grid.7644.10000 0001 0120 3326Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari ‘A Moro’, Bari, Italy
| | - Giuseppe Rengo
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- grid.511455.1Istituti Clinici Scientifici Maugeri SpA Società Benefit-IRCCS-Scientific Institute of Telese Terme, Telese Terme, Italy
| | - Francesco Cacciatore
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ciro Maiello
- grid.416052.40000 0004 1755 4122Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- grid.416052.40000 0004 1755 4122Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania L. Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- grid.416052.40000 0004 1755 4122Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania L. Vanvitelli, Caserta, Italy
| | - Francesco Perticone
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- grid.477084.80000 0004 1787 3414Mediterranea Cardiocentro, Naples, Italy
| | - Stefania Paolillo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- grid.477084.80000 0004 1787 3414Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- grid.8142.f0000 0001 0941 3192Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Volterrani
- grid.18887.3e0000000417581884Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Olga Vriz
- grid.415310.20000 0001 2191 4301Heart Center Department, King Faisal Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- grid.411475.20000 0004 1756 948XDivision of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Passantino
- grid.414603.4Scientific Clinical Institutes Maugeri, IRCCS, Pavia, Italy
| | - Michela Campo
- grid.10796.390000000121049995Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Amedeo Modesti
- grid.8404.80000 0004 1757 2304Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Andrea Salzano
- grid.482882.c0000 0004 1763 1319Italian Clinical Outcome Research and Reporting Program (I-CORRP)-IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Roberta D’Assante
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Michele Arcopinto
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Valeria Raparelli
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Fabbian
- grid.416315.4Clinica Medica Unit, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Angela Sciacqua
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Annamaria Colao
- grid.4691.a0000 0001 0790 385XClinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Toru Suzuki
- grid.412925.90000 0004 0400 6581Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Eduardo Bossone
- grid.413172.2Italian Clinical Outcome Research and Reporting Program (I-CORRP)-Cardiology Division, A. Cardarelli Hospital, Naples, Italy
| | - Antonio Cittadini
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
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Salzano A, D'Assante R, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Sciacqua A, Filardi PP, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Arcopinto M, Gargiulo P, Perticone M, Colao A, Milano S, Garavaglia A, Napoli R, Suzuki T, Bossone E, Marra AM, Cittadini A. Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry. Cardiovasc Diabetol 2022; 21:108. [PMID: 35710369 PMCID: PMC9204878 DOI: 10.1186/s12933-022-01543-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023] Open
Abstract
Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017
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Affiliation(s)
- Andrea Salzano
- IRCCS SYNLAB SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB) - IRCCS - Scientific Institute of Telese Terme, Telese Terme, BN, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ciro Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michela Campo
- Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro A Modesti
- Dipartimento Di Medicina Sperimentale E Clinica, Università Degli Studi Di Firenze, Florence, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Annamaria Colao
- Clinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Salvatore Milano
- Department of Laboratory Medicine, AOUP P. Giaccone, Palermo, Italy
| | | | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Cardiology Division, A Cardarelli Hospital, Naples, Italy
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy. .,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy. .,Department of Translational Medical Sciences, Division of Internal Medicine and Metabolism and Rehabilitation, Federico II University of Naples, Via S. Pansini 5, Bld.18, 1stfloor, 80131, Naples, Italy.
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8
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Cittadini A, Bossone E, Ventura HO. Emerging Comorbidities in Heart Failure. Cardiol Clin 2022; 40:xi-xiv. [DOI: 10.1016/j.ccl.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Triggiani V, Lisco G. Commentary to the article "Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry", Antonio Cittadini et al. Eur J Prev Cardiol. 2021. Endocr Metab Immune Disord Drug Targets 2021; 22:545-548. [PMID: 34911431 DOI: 10.2174/1871530321666211215144023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
Chronic heart failure represents a relevant concern for public health. The endocrine system is heavily involved in the induction and progression of chronic heart failure. Among endocrine dysfunction, the most relevant alterations are related to the growth hormone-insulin like growth factor 1 axis, serum testosterone, dehydroepiandrosterone sulfate, triiodothyronine levels, insulin resistance, and type 2 diabetes mellitus. It is currently debated whether these changes might be simple adaptive mechanisms or, instead, they may deteriorate myocardial pump function over time. Medical management of patients exhibiting one or more hormonal deficiencies or metabolic disorders, including insulin resistance and diabetes mellitus, may have a therapeutic role.
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Affiliation(s)
- Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari. Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari. Italy
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10
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Salzano A, Suzuki T, Squire IB, Cittadini A. Are heart failure observational studies still useful? 'No need to argue'. Eur J Prev Cardiol 2021; 28:1006-1008. [PMID: 32580568 DOI: 10.1177/2047487320932258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Affiliation(s)
- Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Italy
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11
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De Luca M, Crisci G, Giardino F, Valente V, Amaranto I, Iacono O, D'Assante R, Giallauria F, Marra AM. Anabolic hormones and heart failure with preserved ejection fraction: looking for Ariadne's thread. Monaldi Arch Chest Dis 2021; 92. [PMID: 34351104 DOI: 10.4081/monaldi.2021.1743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome that accounts for more than half of all heart failure patients. Identification, early diagnosis and management of patients are still complex, and no targeted treatment is available, since all tested drugs were not able to lower hard clinical outcomes. A multi-hormonal deficiency syndrome has been described in HFpEF patients suggesting that different hormones may represent new biomarkers of the disease, but their clinical utility is still debated. The natriuretic peptides are the cornerstone biomarker in heart failure, predicting cardiovascular death and heart failure hospitalization. Testosterone and DHEA-S deficiencies have been reported in HFpEF and associated with right ventricular impairment and diastolic dysfunction. IGFBP-1/IGF-1 axis correlates with echocardiographic parameters of HFpEF patients and with several prognostic biomarkers including NT-proBNP and C reactive protein. Low triiodothyronine syndrome is frequently found in HFpEF and thyroid hormones should represent a potential biomarker of risk stratification and prognosis.
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Affiliation(s)
| | - Giulia Crisci
- Department of Translational Medical Sciences, "Federico II" University, Naples.
| | - Federica Giardino
- Department of Translational Medical Sciences, "Federico II" University, Naples.
| | - Valeria Valente
- Department of Translational Medical Sciences, "Federico II" University, Naples.
| | - Ilaria Amaranto
- Department of Translational Medical Sciences, "Federico II" University, Naples.
| | - Olimpia Iacono
- Department of Translational Medical Sciences, "Federico II" University, Naples.
| | - Roberta D'Assante
- Department of Translational Medical Sciences, "Federico II" University, Naples.
| | | | - Alberto M Marra
- Department of Translational Medical Sciences, "Federico II" University, Naples.
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12
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Cittadini A, Isidori AM, Salzano A. Testosterone therapy and cardiovascular diseases. Cardiovasc Res 2021; 118:2039-2057. [PMID: 34293112 DOI: 10.1093/cvr/cvab241] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
Since it was first synthesised in 1935, testosterone (T) has been viewed as the mythical Fountain of Youth, promising rejuvenation, restoring sexual appetites, growing stronger muscles, and quicker thinking. T is endowed with direct effects on myocardial and vascular structure and function, as well as on risk factors for cardiovascular (CV) disease. Indeed, low serum T levels are a risk factor for diabetes, metabolic syndrome, inflammation, and dyslipidaemia. Moreover, many studies have shown that T deficiency per se is an independent risk factor of CV and all-cause mortality. On this background and due to direct-to-patient marketing by drug companies, we have witnessed to the widespread use of T replacement therapy (TT) without clear indications particularly in late-life onset hypogonadism. The current review will dwell upon current evidence and controversies surrounding the role of T in the pathophysiology of CV diseases, the link between circulating T levels and CV risk, and the use of replacing T as a possible adjuvant treatment in specific CV disorders. Specifically, recent findings suggest that heart failure and type 2 diabetes mellitus represent two potential targets of T therapy once that a state of hypogonadism is diagnosed. However, only if ongoing studies solve the CV safety issue the T orchid may eventually 'bloom'.
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Affiliation(s)
- Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdisciplinary Research Centre on Biomaterials (CRIB), Federico II University, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
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13
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Abstract
Exercise intolerance represents a typical feature of heart failure with preserved ejection fraction (HFpEF), and is associated with a poor quality of life, frequent hospitalizations, and increased all-cause mortality. The cardiopulmonary exercise test is the best method to quantify exercise intolerance, and allows detection of the main mechanism responsible for the exercise limitation, influencing treatment and prognosis. Exercise training programs improve exercise tolerance in HFpEF. However, studies are needed to identify appropriate type and duration. This article discusses the pathophysiology of exercise limitation in HFpEF, describes methods of determining exercise tolerance class, and evaluates prognostic implications and potential therapeutic strategies.
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14
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Cittadini A, Salzano A, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Cimellaro A, Perrone Filardi P, Paolillo S, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Monte IP, Puzzo A, Ballotta A, D'Assante R, Arcopinto M, Gargiulo P, Sciacqua A, Bruzzese D, Colao A, Napoli R, Suzuki T, Eagle KA, Ventura HO, Marra AM, Bossone E. Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry. Eur J Prev Cardiol 2021; 28:1691-1700. [PMID: 33693736 DOI: 10.1093/eurjpc/zwab020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
AIMS Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients. METHODS AND RESULTS The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of ≥2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction ≤45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P < 0.001). Median follow-up was of 36 months. MHDS was independently associated with the occurrence of the primary endpoint [hazard ratio 95% (confidence interval), 1.93 (1.37-2.73), P < 0.001] and identified a group of patients with a higher mortality [2.2 (1.28-3.83), P = 0.01], with a graded relation between HDs and cumulative events (P < 0.01). CONCLUSION MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT023358017.
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Affiliation(s)
- Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), IRCCS, Scientific Institute of Telese Terme, Telese BN, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ciro Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Antonio Cimellaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michela Campo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Metabolic Diseases, University of Foggia, Foggia, Italy
| | - Pietro A Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Ines P Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | | | - Andrea Ballotta
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Annamaria Colao
- Clinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Kim A Eagle
- Michigan Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Cardiology Division, A Cardarelli Hospital, Naples, Italy
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15
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Salzano A, D'Assante R, Israr MZ, Eltayeb M, D'Agostino A, Bernieh D, De Luca M, Rega S, Ranieri B, Mauro C, Bossone E, Squire IB, Suzuki T, Marra AM. Biomarkers in Heart Failure: Clinical Insights. Heart Fail Clin 2021; 17:223-243. [PMID: 33673947 DOI: 10.1016/j.hfc.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Andrea Salzano
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy.
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Mohamed Eltayeb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Anna D'Agostino
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy
| | - Dennis Bernieh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Salvatore Rega
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Brigida Ranieri
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy
| | - Ciro Mauro
- AORN A Cardarelli, Cardiac Rehabilitation Unit, Naples, Italy
| | - Eduardo Bossone
- AORN A Cardarelli, Cardiac Rehabilitation Unit, Naples, Italy
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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16
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Sciannimanico S, Grimaldi F, Vescini F, De Pergola G, Iacoviello M, Licchelli B, Guastamacchia E, Giagulli VA, Triggiani V. Metformin: Up to Date. Endocr Metab Immune Disord Drug Targets 2020; 20:172-181. [PMID: 31670618 DOI: 10.2174/1871530319666190507125847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Metformin is an oral hypoglycemic agent extensively used as first-line therapy for type 2 diabetes. It improves hyperglycemia by suppressing hepatic glucose production and increasing glucose uptake in muscles. Metformin improves insulin sensitivity and shows a beneficial effect on weight control. Besides its metabolic positive effects, Metformin has direct effects on inflammation and can have immunomodulatory and antineoplastic properties. AIM The aim of this narrative review was to summarize the up-to-date evidence from the current literature about the metabolic and non-metabolic effects of Metformin. METHODS We reviewed the current literature dealing with different effects and properties of Metformin and current recommendations about the use of this drug. We identified keywords and MeSH terms in Pubmed and the terms Metformin and type 2 diabetes, type 1 diabetes, pregnancy, heart failure, PCOS, etc, were searched, selecting only significant original articles and review in English, in particular of the last five years. CONCLUSION Even if many new effective hypoglycemic agents have been launched in the market in the last few years, Metformin would always keep a place in the treatment of type 2 diabetes and its comorbidities because of its multiple positive effects and low cost.
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Affiliation(s)
| | - Franco Grimaldi
- Endocrinology and Metabolism Unit, University Hospital of Udine, Udine, Italy
| | - Fabio Vescini
- Endocrinology and Metabolism Unit, University Hospital of Udine, Udine, Italy
| | - Giovanni De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", School of Medicine, Bari, Italy
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari, Italy
| | - Brunella Licchelli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Italy
| | - Vito A Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Italy
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17
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Muscle Wasting and Sarcopenia in Heart Failure-The Current State of Science. Int J Mol Sci 2020; 21:ijms21186549. [PMID: 32911600 PMCID: PMC7555939 DOI: 10.3390/ijms21186549] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022] Open
Abstract
Sarcopenia is primarily characterized by skeletal muscle disturbances such as loss of muscle mass, quality, strength, and physical performance. It is commonly seen in elderly patients with chronic diseases. The prevalence of sarcopenia in chronic heart failure (HF) patients amounts to up to 20% and may progress into cardiac cachexia. Muscle wasting is a strong predictor of frailty and reduced survival in HF patients. Despite many different techniques and clinical tests, there is still no broadly available gold standard for the diagnosis of sarcopenia. Resistance exercise and nutritional supplementation represent the currently most used strategies against wasting disorders. Ongoing research is investigating skeletal muscle mitochondrial dysfunction as a new possible target for pharmacological compounds. Novel agents such as synthetic ghrelin and selective androgen receptor modulators (SARMs) seem promising in counteracting muscle abnormalities but their effectiveness in HF patients has not been assessed yet. In the last decades, many advances have been accomplished but sarcopenia remains an underdiagnosed pathology and more efforts are needed to find an efficacious therapeutic plan. The purpose of this review is to illustrate the current knowledge in terms of pathogenesis, diagnosis, and treatment of sarcopenia in order to provide a better understanding of wasting disorders occurring in chronic heart failure.
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18
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Salzano A, D'Assante R, Stagnaro FM, Valente V, Crisci G, Giardino F, Arcopinto M, Bossone E, Marra AM, Cittadini A. Heart failure management during the COVID-19 outbreak in Italy: a telemedicine experience from a heart failure university tertiary referral centre. Eur J Heart Fail 2020; 22:1048-1050. [PMID: 32463534 PMCID: PMC7283833 DOI: 10.1002/ejhf.1911] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesca M Stagnaro
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valeria Valente
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Federica Giardino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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19
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Lisco G, De Tullio A, Iacoviello M, Triggiani V. Congestive Heart Failure and Thyroid Dysfunction: The Role of the Low T3 Syndrome and Therapeutic Aspects. Endocr Metab Immune Disord Drug Targets 2020; 20:646-653. [DOI: 10.2174/1871530319666191119112950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 01/13/2023]
Abstract
Background:
Both the morbidity and mortality rates from congestive heart failure (CHF)
remain elevated despite the medical and non-medical management of the disease, thus suggesting the
existence of residual risk factors such as thyroid dysfunction. Particularly, the 15-30% of patients with
CHF, especially those with severe ventricular dysfunction, display the so-called low T3 syndrome
(LT3S), which seems to negatively affect the cardiovascular prognosis.
Objective:
Only a few clinical trials have been carried out to verify both the safety and the efficacy of
thyroid replacement in the LT3S, aiming to ameliorate the prognosis of CHF, and most of the results
were controversial.
Methods:
Since the aim of the present review was to briefly overview both the indication and contraindication
of triiodothyronine replacement in CHF and LT3S, the authors searched PubMed using the
medical subject headings (MeSH) related to the following terms: “congestive heart failure” and “low
T3 syndrome” or “euthyroid sick syndrome” or “non-thyroidal sick syndrome”. The research study
only focused on the narrative and systematic reviews, randomized clinical trials and meta-analysis
studies which were conducted before June 2019.
Results:
Studies conducted in both animal models and humans provided controversial information
about the effectiveness and safety of the T3 replacement for improving ventricular dysfunction, particularly
in the long-term.
Conclusion:
Further clinical trials are needed to better explore the role of LT3S in patients with CHF
and its consequent therapeutic strategy in this clinical setting.
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Affiliation(s)
- Giuseppe Lisco
- Hospital Unit of Internal Medicine, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Anna De Tullio
- Local Health District of Bari, Section of Endocrinology, Bari, Italy
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
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20
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Göbel S, Prochaska JH, Tröbs SO, Panova-Noeva M, Espinola–Klein C, Michal M, Lackner KJ, Gori T, Münzel T, Wild PS. Rationale, design and baseline characteristics of the MyoVasc study: A prospective cohort study investigating development and progression of heart failure. Eur J Prev Cardiol 2020; 28:1009-1018. [DOI: 10.1177/2047487320926438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 01/07/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Heart failure (HF) is a poly-aetiological syndrome with large heterogeneity regarding clinical presentation, pathophysiology, clinical outcome and response to therapy. The MyoVasc study (NCT04064450) is an epidemiological cohort study investigating the development and progression of HF.
Methods
The primary objective of the study is (a) to improve the understanding of the pathomechanisms of HF across the full spectrum of clinical presentation, (b) to investigate the current clinical classifications of HF, and (c) to identify and characterize homogeneous subgroups regarding disease development using a systems-oriented approach. Worsening of HF, that is, the composite of transition from asymptomatic to symptomatic HF, hospitalization due to HF, or cardiac death, was defined as the primary endpoint of the study. During a six-year follow-up period, all study participants receive a highly standardized, biannual five-hour examination in a dedicated study centre, including detailed cardiovascular phenotyping and biobanking of various biomaterials. Annual follow-up examinations are conducted by computer-assisted telephone interviews recording comprehensively the participants´ health status, including subsequent validation and adjudication of adverse events.
Results
In total, 3289 study participants (age range: 35 to 84 years; female sex: 36.8%) including the full range of HF stages were enrolled from 2013 to 2018. Approximately half of the subjects (n=1741) presented at baseline with symptomatic HF (i.e. HF stage C/D). Among these, HF with preserved ejection fraction was the most frequent phenotype.
Conclusions
By providing a large-scale, multi-dimensional biodatabase with sequential, comprehensive medical-technical (sub)clinical phenotyping and multi-omics characterization (i.e. genome, transcriptome, proteome, lipidome, metabolome and exposome), the MyoVasc study will help to advance our knowledge about the heterogeneous HF syndrome by a systems-oriented biomedicine approach.
Trial registration
ClinicalTrials.gov; NCT04064450.
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Affiliation(s)
- Sebastian Göbel
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Jürgen H Prochaska
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- Centre for Thrombosis and Haemostasis, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Sven-Oliver Tröbs
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Marina Panova-Noeva
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Centre for Thrombosis and Haemostasis, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Christine Espinola–Klein
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Karl J Lackner
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Tommaso Gori
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Thomas Münzel
- Centre for Cardiology – Cardiology I, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Philipp S Wild
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
- Centre for Thrombosis and Haemostasis, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
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Abstract
Modifications of lean mass are a frequent critical determinant in the pathophysiology and progression of heart failure (HF). Sarcopenia may be considered one of the most important causes of low physical performance and reduced cardiorespiratory fitness in older patients with HF. Sarcopenia is frequently misdiagnosed as cachexia. However, muscle wasting in HF has different pathogenetic features in sarcopenic and cachectic conditions. HF may induce sarcopenia through common pathogenetic pathways such as hormonal changes, malnutrition, and physical inactivity; mechanisms that influence each other. In the opposite way, sarcopenia may favor HF development by different mechanisms, including pathological ergoreflex. Paradoxically, sarcopenia is not associated with a sarcopenic cardiac muscle, but the cardiac muscle shows a hypertrophy which seems to be “not-functional.” First-line agents for the treatment of HF, physical activity and nutritional interventions, may offer a therapeutic advantage in sarcopenic patients irrespective of HF. Thus, sarcopenia is highly prevalent in patients with HF, contributing to its poor prognosis, and both conditions could benefit from common treatment strategies based on pharmacological, physical activity, and nutritional approaches.
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Bruno C, Silvestrini A, Calarco R, Favuzzi AMR, Vergani E, Nicolazzi MA, d'Abate C, Meucci E, Mordente A, Landolfi R, Mancini A. Anabolic Hormones Deficiencies in Heart Failure With Preserved Ejection Fraction: Prevalence and Impact on Antioxidants Levels and Myocardial Dysfunction. Front Endocrinol (Lausanne) 2020; 11:281. [PMID: 32477267 PMCID: PMC7235369 DOI: 10.3389/fendo.2020.00281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/15/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose: In heart failure with reduced ejection fraction, catabolic mechanisms have a strong negative impact on mortality and morbidity. The relationship between anabolic hormonal deficiency and heart failure with preserved ejection fraction (HFpEF) has still been poorly investigated. On the other hand, oxidative stress is recognized as a player in the pathogenesis of HFpEF. Therefore, we performed a cohort study in HFpEF aimed to (1) define the multi-hormonal deficiency prevalence in HFpEF patients; (2) investigate the relationships between hormonal deficiencies and echocardiographic indexes; (3) explore the modulatory activity of anabolic hormones on antioxidant systems. Methods: 84 patients with diagnosis of HFpEF were enrolled in the study. Plasma levels of N-terminal pro-brain natriuretic peptide, fasting glucose, insulin, lipid pattern, insulin-like growth factor-1, dehydroepiandrosterone-sulfate (DHEA-S), total testosterone (T, only in male subjects) were evaluated. Hormonal deficiencies were defined according to T.O.S.C.A. multi-centric study, as previously published. An echocardiographic evaluation was performed. Plasma total antioxidant capacity (TAC) was measured using the system metmyoglobin -H2O2 and the chromogen ABTS, whose radical form is spectroscopically revealed; latency time (LAG) in the appearance of ABTS• is proportional to antioxidants in sample. Results: Multiple deficiencies were discovered. DHEA-S deficiency in 87% of patients, IGF-1 in 67% of patients, T in 42%. Patients with DHEA-S deficiency showed lower levels of TAC expressed by LAG (mean ± SEM 91.25 ± 9.34 vs. 75.22 ± 4.38 s; p < 0.05). No differences between TAC in patients with or without IGF-1 deficiency were found. A trend toward high level of TAC in patients without hormonal deficiencies compared with patients with one or multiple deficiencies was found. Regarding echocardiographic parameters, Left Atrial and Left Atrial Volume Index were significantly higher in patients with low IGF-1 values (mean ± SD 90.84 ± 3.86 vs. 72.83 ± 3.78 mL; 51.03 ± 2.33 vs. 40.56 ± 2.46 mL/m2, respectively; p < 0.05). Conclusions: Our study showed high prevalence of anabolic deficiencies in HFpEF. DHEA-S seems to influence antioxidant levels; IGF-1 deficiency was associated with alteration in parameters of myocardial structure and dysfunction. These data suggest a role of anabolic hormones in the complex pathophysiological mechanisms of HFpEF and could represent the basis for longitudinal studies and investigations on possible benefits of replacement therapy.
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Affiliation(s)
- Carmine Bruno
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
| | - Andrea Silvestrini
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Andrea Silvestrini
| | - Rodolfo Calarco
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
| | - Angela M. R. Favuzzi
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
| | - Edoardo Vergani
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
| | - Maria Anna Nicolazzi
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
| | - Claudia d'Abate
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
| | - Elisabetta Meucci
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alvaro Mordente
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raffaele Landolfi
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
| | - Antonio Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario a Gemelli IRCCS, Rome, Italy
- Antonio Mancini
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Salzano A, Marra AM, Arcopinto M, D'Assante R, Triggiani V, Coscioni E, Pasquali D, Rengo G, Suzuki T, Bossone E, Cittadini A. Combined effects of growth hormone and testosterone replacement treatment in heart failure. ESC Heart Fail 2019; 6:1216-1221. [PMID: 31696666 PMCID: PMC6989300 DOI: 10.1002/ehf2.12520] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/09/2019] [Accepted: 08/25/2019] [Indexed: 12/16/2022] Open
Abstract
Aims Although preliminary studies have demonstrated safety and effectiveness of single replacement therapy for growth hormone deficiency or testosterone deficiency in heart failure (HF), no data are available regarding the combined treatment with both GH and T in this setting. Thus, the aim of the present hypothesis generating pilot study was to evaluate the effectiveness and safety of multiple hormonal replacement therapies in chronic HF. Methods and results Five stable HF with reduced ejection fraction patients, with a concomitant diagnosis of growth hormone deficiency and testosterone deficiency, on top of guideline‐based HF treatment underwent 1 year of GH replacement therapy by subcutaneous injections of somatotropin at a dose of 0.012 mg/kg every second day. After 12 months, a T replacement treatment was added at a dosage of 1000 mg every 3 months. Each patient underwent a complete M‐mode, two‐dimensional, and Doppler echocardiographic examination, and an incremental symptom‐limited cardiopulmonary exercise test on a bicycle ergometer at baseline (BL), after 1 year of GH treatment (V1), and after 1 year of combined GH + T treatments (V2). One‐year of GH treatment resulted in a significant improvement in left ventricular ejection fraction (+5.4%, P < 0.01), New York Heart Association functional class (P < 0.05), and peak oxygen consumption (VO2 peak) (+19.3%, P < 0.01), and in a significant reduction in NT‐proBNP levels (−35.1%, P < 0.01). Notably, one additional year of combined GH and T replacement therapy induced a further increase in VO2 peak (+27.7%, final delta change + 52.44%, P < 0.01), as well as a significant improvement in muscular strength, as assessed by handgrip dynamometry (+17.5%, final delta change + 25.8%, P < 0.01). These beneficial effects were paralleled with an improvement of the overall clinical status (as assessed by New York Heart Association class). Of note, neither adverse effects nor cardiovascular events were reported during the follow‐up period. Conclusions Our preliminary data suggest for the first time that combined replacement therapy with GH and T could be considered safe and therapeutic in HF patients with multiple hormone deficiencies, supporting the hypothesis that multiple hormone deficiencies syndrome can be considered as a novel and promising therapeutic target in HF. Further studies with a more robust design and larger population are needed.
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Affiliation(s)
- Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Alberto M Marra
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Division of Internal Medicine & Metabolism & Rehabilitation, Federico II University, Naples, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Division of Internal Medicine & Metabolism & Rehabilitation, Federico II University, Naples, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology, and Rare Diseases, University Aldo Moro, Bari, Italy
| | - Enrico Coscioni
- Department 'Cuore', University Hospital San Giovanni di Dio e Rungi d'Aragona, Salerno, Italy
| | - Daniela Pasquali
- Department of Neurological, Metabolic, and Geriatric Sciences, Endocrinology Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Division of Internal Medicine & Metabolism & Rehabilitation, Federico II University, Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), Telese Terme, Benevento, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Antonio Cittadini
- Department of Translational Medical Sciences, Division of Internal Medicine & Metabolism & Rehabilitation, Federico II University, Naples, Italy.,Interdisciplinary Research Centre in Biomedical Materials (CRIB), Naples, Italy
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Iacoviello M, Parisi G, Gioia MI, Grande D, Rizzo C, Guida P, Lisi F, Giagulli VA, Licchelli B, Di Serio F, Guastamacchia E, Triggiani V. Thyroid Disorders and Prognosis in Chronic Heart Failure: A Long-Term Follow-Up Study. Endocr Metab Immune Disord Drug Targets 2019; 20:437-445. [PMID: 31656160 DOI: 10.2174/1871530319666191018134524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Thyroid disorders may have a negative impact on the prognosis of patients affected by chronic heart failure (CHF). OBJECTIVE The aim of the current study was to evaluate the prognostic role of all thyroid disorders over a long term follow-up in a single centre large sample of CHF outpatients. METHODS In all patients, the function of the thyroid was evaluated at the enrolment and during the follow- up. On the basis of free triiodothyronine (T3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) serum levels, patients were classified into one of the following four categories: euthyroid subjects, patients affected by hypothyroidism, low T3 (LT3) syndrome and hyperthyroidism. During the follow-up, death for all causes was assessed as primary end-point, whereas time to the first hospitalization for heart failure worsening was the secondary end-point analyzed. RESULTS Among 762 patients, 190 patients were affected by hypothyroidism (Hypo). LT3 syndrome was diagnosed in 15 patients and 59 patients were affected by hyperthyroidism (Hyper). During a long term follow-up (5.1±3.7 years), 303 patients died. Patients with Hypo showed an increased risk of death as well as of hospitalization due to heart failure worsening at univariate regression analysis. At multivariate regression analysis, Hypo remained associated with hospitalization after correction for age >75 years, ischemic aetiology, diabetes, therapy with ACE-inhibitors or ARBs, therapy with betablockers and with aldosterone antagonists, NYHA class 3, systolic arterial pressure <95 mmHg, left ventricular ejection fraction <30%, estimated glomerular filtration rate <60 ml/min, hyponatremia and NTproBNP> 1000 pg/ml. At multivariate analysis, the independent association with death was significant only for the subgroup of patients with TSH >10 mIU/L. LT3 was independently associated with both heart failure hospitalization and death, whereas Hyper was not associated with any of the two considered end-points. CONCLUSION Hypo is associated with a worse prognosis over a long-term follow-up. The association with heart failure hospitalization is not dependent on the baseline TSH levels, whereas the association with death is significant only when TSH >10 mIU/L. Finally, Hyper does not have any association with a worse prognosis.
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Affiliation(s)
- Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari, Italy
| | | | | | - Dario Grande
- School of Cardiology, University of Bari, Bari, Italy
| | - Caterina Rizzo
- Cardiology Division, S. Maugeri Foundation, Cassano delle Murge, Bari, Italy
| | - Pietro Guida
- Cardiology Division, S. Maugeri Foundation, Cassano delle Murge, Bari, Italy
| | | | - Vito A Giagulli
- Intedisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari, Bari, Italy
| | - Brunella Licchelli
- Intedisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari, Bari, Italy
| | | | - Edoardo Guastamacchia
- Intedisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari, Bari, Italy
| | - Vincenzo Triggiani
- Intedisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari, Bari, Italy
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Marra AM, Proietti M, Bossone E, Salzano A, Cittadini A. Risk stratification in hospitalized heart failure patients: do the RIGHT thing! Intern Emerg Med 2019; 14:1021-1023. [PMID: 31214885 DOI: 10.1007/s11739-019-02121-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | - Marco Proietti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Eduardo Bossone
- Cardiology Unit, "Antonio Cardarelli" Hospital, Naples, Italy
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Andrea Salzano
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP, UK
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Antonio Cittadini
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP, UK
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
- Interdisciplinary Research Centre in Biomedical Materials (C.R.I.B.), Federico II" University, Naples, Italy
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D'Assante R, Napoli R, Salzano A, Pozza C, Marra AM, Arcopinto M, Perruolo G, Milano S, Formisano P, Saldamarco L, Cirillo P, Cittadini A. Human heart shifts from IGF-1 production to utilization with chronic heart failure. Endocrine 2019; 65:714-716. [PMID: 31267324 DOI: 10.1007/s12020-019-01993-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/22/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Roberta D'Assante
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Andrea Salzano
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Michele Arcopinto
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
- Emergency Department, A Cardarelli Hospital, Naples, Italy
| | - Giuseppe Perruolo
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Salvatore Milano
- Department of Laboratory Medicine, CoreLab, AOUP "P. Giaccone", University of Palermo, Palermo, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University of Naples, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy.
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Marsico F, Gargiulo P, Marra AM, Parente A, Paolillo S. Glucose Metabolism Abnormalities in Heart Failure Patients. Heart Fail Clin 2019; 15:333-340. [DOI: 10.1016/j.hfc.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Gargiulo P, Paolillo S, Ferrazzano F, Prastaro M, La Mura L, De Roberto AM, Diana G, Dell'Aversana S, Contiello C, Vozzella MC, Bardi L, Marsico F. Prognostic Value of Hormonal Abnormalities in Heart Failure Patients. Heart Fail Clin 2019; 15:371-375. [PMID: 31079695 DOI: 10.1016/j.hfc.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The model used to explain the pathophysiologic substrate and progressive worsening in chronic heart failure (CHF) is based on the hyperactivity of renin-angiotensin-aldosterone system and adrenergic pathway. Although the neurohormonal medical approach has many advantages, it has several pitfalls, as demonstrated by high rates of CHF mortality and hospitalization. A growing body of evidence has led to the hypothesis that CHF is a multiple hormone deficiency syndrome, characterized by a reduced anabolic drive that has relevant functional and prognostic implications. The aim of this review is to summarize the evidence of reduced drive of main anabolic axes in CHF.
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Affiliation(s)
| | | | - Francesca Ferrazzano
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Anna Maria De Roberto
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Gaetano Diana
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Simona Dell'Aversana
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Cristina Contiello
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Maria Cristina Vozzella
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Luca Bardi
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Fabio Marsico
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
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Salzano A, D'Assante R, Lander M, Arcopinto M, Bossone E, Suzuki T, Cittadini A. Hormonal Replacement Therapy in Heart Failure: Focus on Growth Hormone and Testosterone. Heart Fail Clin 2019; 15:377-391. [PMID: 31079696 DOI: 10.1016/j.hfc.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A growing body of evidence led to the hypothesis that heart failure (HF) could be considered a multiple hormone deficiency syndrome. Deficiencies in the main anabolic axes cannot be considered as mere epiphenomena, are very common in HF, and are clearly associated with poor cardiovascular performance and outcomes. Growth hormone deficiency and testosterone deficiency play a pivotal role and the replacement treatment is an innovative therapy that should be considered. This article appraises the current evidence regarding growth hormone and testosterone deficiencies in HF and reviews novel findings about the treatment of these conditions in HF.
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Affiliation(s)
- Andrea Salzano
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK; Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples 80138, Italy
| | | | - Mark Lander
- Department of Acute Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples 80138, Italy; Emergency Department, A Cardarelli Hospital, Via Cardarelli 9, Naples 80131, Italy
| | - Eduardo Bossone
- Cardiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples 80131, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples 80138, Italy; Interdisciplinary Research Centre in Biomedical Materials (CRIB), Piazzale Tecchio 80, Naples 80125, Italy.
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Salzano A, Marra AM, D’Assante R, Arcopinto M, Bossone E, Suzuki T, Cittadini A. Biomarkers and Imaging. Heart Fail Clin 2019; 15:321-331. [DOI: 10.1016/j.hfc.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Biomarkers in Heart Failure and Associated Diseases. DISEASE MARKERS 2019; 2019:8768624. [PMID: 30881524 PMCID: PMC6383412 DOI: 10.1155/2019/8768624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
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Brankovic M, Akkerhuis KM, Umans V, Boersma E, Kardys I. Response to Letter to the Editor: "Cardiometabolic Biomarkers and Their Temporal Patterns Predict Poor Outcome in Chronic Heart Failure (Bio-SHiFT Study)". J Clin Endocrinol Metab 2019; 104:736-737. [PMID: 30339257 DOI: 10.1210/jc.2018-02149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 02/13/2023]
Affiliation(s)
- Milos Brankovic
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Victor Umans
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
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Holndonner-Kirst E, Nagy A, Czobor NR, Fazekas L, Dohan O, Kertai MD, Lex DJ, Sax B, Hartyanszky I, Merkely B, Gal J, Szekely A. The Impact of l-Thyroxine Treatment of Donors and Recipients on Postoperative Outcomes After Heart Transplantation. J Cardiothorac Vasc Anesth 2018; 33:1629-1635. [PMID: 30467031 DOI: 10.1053/j.jvca.2018.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The effect of thyroid dysfunction on adverse outcomes has been studied in many different patient populations. The objective of this study was to investigate the effect of thyroid hormone supplementation of donors and recipients on postoperative outcomes after orthotopic heart transplantation. DESIGN Retrospective. SETTING Single center, university hospital. PARTICIPANTS Two-hundred and sixty-six consecutive patients undergoing heart transplantation. INTERVENTIONS No interventions. MEASUREMENTS AND MAIN RESULTS Demographic, hemodynamic, and clinical characteristics; donor and recipient United Network for Organ Sharing scores; and information on thyroid hormone support of donors and recipients were recorded. During the median follow-up of 4.59 years (interquartile range 4.26-4.92 y), 70 patients (26.3%) died. After adjustments were made for the United Network for Organ Sharing score, recipients who were treated preoperatively with l-thyroxine had a lower risk for all-cause mortality (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.06-0.98; p = 0.047) compared with recipients who were not treated with l-thyroxine. In addition, l-thyroxine treatment of donors was associated with a better recipient survival (HR 0.31, 95% CI 0.11-0.87; p = 0.025). CONCLUSIONS Pretransplantation thyroid hormone supplementation of donors and recipients was associated with improved long-term survival after heart transplantation.
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Affiliation(s)
- Eniko Holndonner-Kirst
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary; School of Doctoral Studies, Semmelweis University, Budapest, Hungary
| | - Adam Nagy
- School of Doctoral Studies, Semmelweis University, Budapest, Hungary
| | - Nikoletta Rahel Czobor
- School of Doctoral Studies, Semmelweis University, Budapest, Hungary; Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Levente Fazekas
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Orsolya Dohan
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Balazs Sax
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Janos Gal
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Andrea Szekely
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
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Multiple hormone deficiency syndrome: a novel topic in chronic heart failure. Future Sci OA 2018; 4:FSO311. [PMID: 30057788 PMCID: PMC6060397 DOI: 10.4155/fsoa-2018-0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/20/2022] Open
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