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Scicchitano P, Iacoviello M, Passantino A, Gesualdo M, Trotta F, Basile M, De Palo M, Guida P, Paolillo C, Riccioni G, Ciccone MM, Caldarola P, Massari F. Plasma Levels of Intact Parathyroid Hormone and Congestion Burden in Heart Failure: Clinical Correlations and Prognostic Role. J Cardiovasc Dev Dis 2022; 9:jcdd9100334. [PMID: 36286286 PMCID: PMC9604445 DOI: 10.3390/jcdd9100334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Circulating parathyroid hormone (PTH) concentrations increase in heart failure (HF) and are related to disease severity. The relationship between PTH and congestion is still a matter of debate. The objective of this analysis was to evaluate the role of PTH as a marker of congestion and prognosis in HF. We enrolled 228 patients with HF. Intact PTH concentrations and HYDRA score (constituted by: B-type natriuretic peptide, blood urea nitrogen−creatinine ratio, estimated plasma volume status, and hydration status) were evaluated. The study endpoint was all-cause mortality. PTH levels were higher in acute compared with chronic HF and in patients with clinical signs of congestion (i.e., peripheral oedema and orthopnea). PTH concentrations significantly correlated with NYHA class and HYDRA score. At multivariate analysis of HYDRA score, estimated glomerular filtration rate (eGFR), and corrected serum calcium were independently determinants of PTH variability. Fifty patients (22%) died after a median follow-up of 408 days (interquartile range: 283−573). Using univariate Cox regression analysis, PTH concentrations were associated with mortality (hazard ratio [HR]: 1.003, optimal cut-off: >249 pg/mL—area under-the-curve = 0.64). Using multivariate Cox regression analysis, PTH was no longer associated with death, whereas HYDRA score, left ventricular ejection fraction, and eGFR acted as independent predictors for mortality (HR: 1.96, 0.97, and 0.98, respectively). Our study demonstrated that intact PTH was related to clinical and subclinical markers of congestion. However, intact PTH did not act as an independent determinant of all-cause death in HF patients.
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Affiliation(s)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, FG, Italy
| | - Andrea Passantino
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS Institute of Bari, 70124 Bari, BA, Italy
| | - Michele Gesualdo
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
| | - Francesco Trotta
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
| | - Marco Basile
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
| | - Micaela De Palo
- Cardiac Surgery Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, BA, Italy
| | - Piero Guida
- Ospedale Generale Regionale “F. Miulli”, 70021 Acquaviva delle Fonti, BA, Italy
| | - Claudio Paolillo
- Cardiology Section, Hospital “Umberto I”, 70033 Corato, BA, Italy
| | - Graziano Riccioni
- Cardiology Unit, San Camillo de Lellis, Hospital, Via Isonzo 1, 71043 Manfredonia, FG, Italy
| | - Marco Matteo Ciccone
- Cardiology Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, BA, Italy
| | | | - Francesco Massari
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
- Correspondence:
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Loncar G, Bozic B, Cvetinovic N, Dungen HD, Lainscak M, von Haehling S, Doehner W, Radojicic Z, Putnikovic B, Trippel T, Popovic V. Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure. J Endocrinol Invest 2017; 40:297-304. [PMID: 27738907 DOI: 10.1007/s40618-016-0561-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/05/2016] [Indexed: 01/06/2023]
Abstract
AIM Evaluation of secondary hyperparathyroidism (SHPT) and its prognostic impact on all-cause mortality in elderly males with heart failure (HF). METHODS Seventy three males (67 ± 7 years old) with systolic HF were included. Baseline PTH was measured. Patients were grouped according to PTH cut-off levels of 65 pg/ml (>65 pg/ml = SHPT vs. normal PTH). All-cause mortality was evaluated at 6-year follow-up. RESULTS SHPT was diagnosed in 43 (59 %) patients. They were more severe compared to the patients with normal PTH regarding NYHA functional class (2.4 ± 0.5 vs. 2.1 ± 0.2, p = 0.001), quality of life score (34 ± 14 vs. 24 ± 12, p = 0.005), 6-min walking distance (378 ± 79 vs. 446 ± 73 m, p < 0.0001), left ventricular ejection fraction (27 ± 8 vs. 31 ± 7 %, p = 0.019), and NT-proBNP [2452 (3399) vs. 918 (1372) pg/ml, p < 0.0001]. No differences in age, vitamin D status, and renal function were noted between studied groups. A total of 41 (56 %) patients died within 6 years of follow-up. Kaplan-Meier survival analysis showed impaired long-term survival in patients with SHPT versus patients with normal PTH (p = 0.009). The rate of death was highest (75 %) in the group of patients with SHPT and NT-proBNP levels above median value (p = 0.003). Cox regression analysis demonstrated that NT-proBNP was the single independent predictor of all-cause mortality at 6-year follow-up [HR 3.698 (1.927-7.095), p < 0.0001]. CONCLUSION SHPT was highly prevalent in elderly males with HF and was associated with impaired survival. HF patients with SHPT had more severe disease compared to the patients with normal serum PTH. Determination of serum PTH levels provided additional value to NT-proBNP for risk stratification in these patients.
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Affiliation(s)
- G Loncar
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - B Bozic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
- Institute for Physiology and Biochemistry, University of Belgrade, Belgrade, Serbia
| | - N Cvetinovic
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia
| | - H-D Dungen
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Lainscak
- Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - S von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Göttingen, Germany
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - W Doehner
- Center for Stroke Research Berlin, Charite University Medical School, Berlin, Germany
| | - Z Radojicic
- Institute for Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - B Putnikovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - T Trippel
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - V Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
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Tevik K, Thürmer H, Husby MI, de Soysa AK, Helvik AS. Nutritional risk is associated with long term mortality in hospitalized patients with chronic heart failure. Clin Nutr ESPEN 2016; 12:e20-e29. [PMID: 28531665 DOI: 10.1016/j.clnesp.2016.02.095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS Mortality among patients with chronic heart failure (CHF) is still high despite progress in medical and surgical treatment. The patients' nutritional condition may play an important role, and needs further investigation. The aim of this study was to evaluate whether nutritional risk in hospitalized patients with CHF was associated with three-year mortality. METHODS A prospective study was conducted in 131 hospitalized Norwegian patients with CHF. Nutritional screening was performed using Nutritional Risk Screening (NRS-2002). The primary clinical outcome was death from any cause. RESULTS The prevalence of nutritional risk was 57% (NRS-2002 score ≥ 3). The overall mortality rate was 52.6% within three-year follow up. More patients at nutritional risk (N = 51) died compared to patients not at nutritional risk (N = 18) (P < 0.001). In adjusted analyses patients at nutritional risk had more than five-time higher odds (OR 5.85; 95% CI 2.10-16.24) to die before three-year follow-up than those not at nutritional risk. In adjusted Cox multivariate analysis, the nutritional risk was associated with increased mortality (HR 2.78; 95% CI 1.53-5.03). Furthermore, in adjusted analysis components in NRS-2002 were associated with mortality, i.e. nutritional status (HR 1.82; 95% CI 1.03-3.22), severity of disease (NYHA-class IV) (HR 1.78; 95% CI 1.00-3.16) and age (≥ 70 year) (HR 3.24; 95% CI 1.48-7.10). CONCLUSION Nutritional risk as defined by NRS-2002 in hospitalized patients with CHF was significantly associated with long term mortality.
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Affiliation(s)
- Kjerstin Tevik
- Department of Cardiology, St. Olav's University Hospital, Postbox 3250 Sluppen, 7006 Trondheim, Norway; Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, NO-7491 Trondheim, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Postbox 2136, 3013 Tønsberg, Norway.
| | - Hanne Thürmer
- Telemark Hospital, Medical Department, Postbox 234, 3672 Notodden, Norway.
| | - Marit Inderhaug Husby
- Department of Cardiology, St. Olav's University Hospital, Postbox 3250 Sluppen, 7006 Trondheim, Norway.
| | - Ann Kristin de Soysa
- Department of Clinical Nutrition, St. Olav's University Hospital, Postbox 3250 Sluppen, 7006 Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, NO-7491 Trondheim, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Postbox 2136, 3013 Tønsberg, Norway; St. Olav's University Hospital, Postbox 3250 Sluppen, 7006 Trondheim, Norway.
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