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Levels of Serum IGF-1, HCY, and Plasma BNP in Patients with Chronic Congestive Heart Failure and Their Relationship with Cardiac Function and Short-Term Prognosis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4118976. [PMID: 36051497 PMCID: PMC9427243 DOI: 10.1155/2022/4118976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022]
Abstract
Objective To investigate the levels of serum insulin like growth factor-1 (IGF-1), homocysteine (HCY), and plasma brain natriuretic peptide (BNP) in patients with chronic congestive heart failure (CCHF) and their relationship with cardiac function and short-term prognosis. Methods A total of 95 patients with CCHF admitted to our hospital from October 2017 to December 2018 were selected as the observation group. Patients conform to grade II∼IV of the New York Heart Association (NYHA) heart function class. At the same time, the people with normal physical examination results were selected as a control group. Serum IGF-1, HCY, and plasma BNP levels were detected in the two groups, and left ventricular end-diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) were detected in the observation group. According to the follow-up results, the observation group was divided into the subgroup with good prognosis and the subgroup with poor prognosis. The relationship between the levels of serum IGF-1, HCY, and plasma BNP among cardiac function and short-term prognosis were analyzed. Results The serum IGF-1 level of the observation group was lower than that of the control group, and the serum HCY and plasma BNP levels were higher than those of the control group (P < 0.05). Serum IGF-1 level in grade III of NYHA was lower than that in grade II, and serum HCY and plasma BNP levels were higher than those in grade II. Serum IGF-1 level in grade IV was lower than that in grade II and grade III, and serum HCY and plasma BNP levels were higher than those in grade II and grade III (P < 0.05). Serum IGF-1 level was negatively correlated with LVDd and positively correlated with LVEF. Serum HCY and plasma BNP levels were positively correlated with LVDd and negatively correlated with LVEF (P < 0.05). There were 42 patients with poor prognoses (44.21%). Serum IGF-1 levels of patients with poor prognosis were lower than those with good prognosis, and serum HCY and plasma BNP levels were higher than those with good prognosis (P < 0.05). Conclusion The serum IGF-1 level in patients with CCHF decreased, and serum HCY and plasma BNP levels increased. Serum IGF-1, HCY, and plasma BNP were correlated with cardiac function and have some clinical value for short-term prognosis.
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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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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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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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D'Assante R, Arcopinto M, Rengo G, Salzano A, Walser M, Gambino G, Monti MG, Bencivenga L, Marra AM, Åberg DN, De Vincentiis C, Ballotta A, Bossone E, Isgaard J, Cittadini A. Myocardial expression of somatotropic axis, adrenergic signalling, and calcium handling genes in heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:1681-1686. [PMID: 33512777 PMCID: PMC8006736 DOI: 10.1002/ehf2.13067] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Limited data are available regarding cardiac expression of molecules involved in heart failure (HF) pathophysiology. The majority of the studies have focused on end‐stage HF with reduced ejection fraction (HFrEF) without comparison with healthy subjects, while no data are available with regard to HF with preserved ejection fraction (HFpEF). HFpEF is a condition whose multiple pathophysiological mechanisms are still not fully defined, with many proposed hypotheses remaining speculative due to limited access to human heart tissue. This study aimed at evaluating cardiac expression levels of key genes of interest in human biopsy samples from patients affected with HFrEF and HFpEF in order to possibly point out distinct phenotypes. Methods and results Total RNA was extracted from left ventricular cardiac biopsies collected from stable patients with HFrEF (n = 6) and HFpEF (n = 7) and healthy subjects (n = 9) undergoing elective cardiac surgery for valvular replacement, mitral valvuloplasty, aortic surgery, or coronary artery bypass. Real‐time PCR was performed to evaluate the mRNA expression levels of genes involved in somatotropic axis regulation [IGF‐1, IGF‐1 receptor (IGF‐1R), and GH receptor (GHR)], in adrenergic signalling (GRK2, GRK5, ADRB1, and ADRB2), in myocardial calcium handling (SERCA2), and in TNF‐α. Patients with HFrEF and HFpEF showed reduced serum IGF‐1 circulating levels when compared with controls (102 ± 35.6, 138 ± 11.5, and 160 ± 13.2 ng/mL, P < 0.001, respectively). At myocardial level, HFrEF showed significant decreased GHR and increased IGF‐1R expressions when compared with HFpEF and controls (0.54 ± 0.27, 0.94 ± 0.25, and 0.84 ± 0.2, P < 0.05 and 1.52 ± 0.9, 1.06 ± 0.21, and 0.72 ± 0.12, P < 0.05, respectively), while no differences in the local expression of IGF‐1 mRNA were detected among the groups (0.80 ± 0.45, 0.97 ± 0.18, and 0.63 ± 0.23, P = 0.09, respectively). With regard to calcium handling and adrenergic signalling, HFrEF displayed significant decreased levels of SERCA2 (0.19 ± 0.39, 0.82 ± 0.15, and 0.87 ± 0.32, P < 0.01) and increased levels of GRK2 (3.45 ± 2.94, 0.93 ± 0.12, and 0.80 ± 0.14, P < 0.01) and GRK5 (1.32 ± 0.70, 0.71 ± 0.14, and 0.77 ± 0.15, P < 0.05), while no significant difference was found in ADRB1 (0.66 ± 0.4, 0.83 ± 0.3, and 0.86 ± 0.4) and ADRB2 mRNA expression (0.65 ± 0.3, 0.66 ± 0.2, and 0.68 ± 0.1) when compared with HFpEF and controls. Finally, no changes in the local expression of TNF‐α were detected among groups. Conclusions Heart failure with reduced ejection fraction and HFpEF patients with stable clinical condition display a distinct molecular milieu of genes involved in somatotropic axis regulation, calcium handling, and adrenergic derangement at a myocardial level. The unique opportunity to compare these results with a control group, as reference population, may contribute to better understand HF pathophysiology and to identify novel potential therapeutic targets that could be modulated to improve ventricular function in patients with HF.
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Affiliation(s)
- Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB) - IRCCS - Scientific Institute of Telese Terme, Telese Terme, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Marion Walser
- Department of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Giuseppina Gambino
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy
| | - Maria Gaia Monti
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy
| | - David N Åberg
- Department of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Carlo De Vincentiis
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea Ballotta
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Eduardo Bossone
- Division of Cardiology, A. Cardarelli Hospital, Naples, Italy
| | - Jörgen Isgaard
- Department of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, Naples, 80138, Italy
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